Compositions and methods for treating rosacea and acne

ABSTRACT

Provided are compositions and methods for treating rosacea and acne. Specifically, a gel or foam composition having a tetracycline antibiotic and uses thereof for treating rosacea and acne are provided.

The present application claims the benefit of priority to U.S.Provisional Patent Application No. 62/385,189 filed Sep. 8, 2016; U.S.Provisional Patent Application No. 62/393,545 filed Sep. 12, 2016; U.S.Provisional Patent Application No. 62/444,960 filed Jan. 11, 2017; andU.S. Provisional Patent Application No. 62/550,158 filed Aug. 25, 2017;the entire contents of each are incorporated herein by reference.

BACKGROUND

Rosacea is a chronic acneiform disorder affecting skin and potentiallythe eye. It is a syndrome of undetermined etiology characterized by bothvascular and papulopustular components involving the face andoccasionally the neck, scalp, ears and upper trunk. Clinical findingsinclude mid facial erythema, telangiectasis, papules and pustules, andsebaceous gland hypertrophy. Rosacea is characterized by episodicflushing of affected areas, which can be triggered by various factors,such as consumption of alcohol, hot drinks, spicy foods or physicalexercise. Facial rosacea is classified/graded in multiple clinicalforms: (1) erythematotelangiectatic rosacea which is characterized by(semi-) permanent erythema and/or flushing; (2) papulopustular rosacea,characterized by presence of inflammatory lesions such as papules andpustules; (3) phymatous rosacea characterized by circumscribed permanentswelling/thickening of skin areas, typically the nose; and (4) ocularrosacea characterized by the appearance of redness in eyes and eyelidsdue to telangiectasias and inflammation, feeling of dryness, irritation,or gritty, foreign body sensations, itching, burning, stinging, andsensitivity to light, eyes being susceptible to infection, or blurryvision.

Rosacea occurs most commonly in adult life, between the ages of 30 and60 years. It is very common in skin types I-II (according Fitzpatrick)and more common in Caucasians, with a prevalence of up to 5% in the U.S.and in Europe. It is estimated that from 10 to 20 million Americans havethe condition.

Topical treatments for rosacea include metronidazole, azelaic acid andbrimonidine tartrate. However, approved topical therapies rarely showsufficient clinical efficacy or provide only cosmetic relief for severalhours. Mainstays of treatment for rosacea are the oral tetracyclines:doxycycline and minocycline. Low-dose systemic doxycycline (Oracea®resp. Oraycea®) is approved for rosacea whereas systemic minocycline isused in many cases for rosacea off-label. Minocycline is generallyregarded as having less photosensitivity than doxycycline. The long-termuse of systemic antibiotics is limited by potential liver toxicity,phototoxicity, drug-drug interactions and development of antibacterialresistance. Hence, an efficacious topical tetracycline formulation ishighly warranted to close this medical gap.

“Acne” is a general term that describes another very common skindisorder, which afflicts many people. The prevalence of adult acne isabout 3% in men and between about 11% and 12% in women. Moderate tosevere acne is observed in 14% of acne patients. There are various typesof acne recognized in the field, including, for example: acne vulgarisand acne conglobata. Acne vulgaris (cystic acne or simply acne) isgenerally characterized by areas of skin with seborrhea (scaly redskin), comedones (blackheads and whiteheads), papules (pinheads),pustules (pimples), nodules (large papules) and/or possibly scarring.Acne vulgaris may affect the face, the upper part of the chest, and theback. Severe acne vulgaris is inflammatory, but acne vulgaris can alsomanifest in non-inflammatory forms. Acne conglobata is a severe form ofacne, and may involve many inflamed nodules that are connected under theskin to other nodules. Acne conglobata often affects the neck, chest,arms, and buttocks.

There are typically three levels of acne vulgaris: mild, moderate, andsevere. Mild acne vulgaris is characterized by the presence of few toseveral papules and pustules, but no nodules. Patients with moderateacne typically have several to many papules and pustules, along with afew to several nodules. With severe acne vulgaris, patients typicallyhave numerous or extensive papules and pustules, as well as manynodules.

Acne may also be classified by the type of lesion: comedonal,papulopustular, and nodulocystic. Pustules and cysts are consideredinflammatory acne.

Mild to moderate acne is often treated topically, using, e.g.,retinoids, benzoyl peroxide and some antibiotics. Topical retinoids arecomedolytic and anti-inflammatory. Antibiotics such as tetracyclineantibiotics are generally only available orally or by injection. Topicalantibiotics are mainly used for their role against P. acnes. Benzoylperoxide products are also effective against P. acnes. Unfortunately,these medications can lack satisfactory safety and efficacy profiles. Inone or more embodiments, there are provided herein new and bettertopical anti-acne treatments and formulations.

Diagnosis of acne vulgaris may begin with a visual inspection todetermine the presence and amount of comedones, papules, pustules,nodules, and other inflammatory lesions. A diagnosis of acne vulgarismay also be confirmed via clinical laboratory tests, for example,measurement of testosterone levels and performing skin lesion cultures.

Systemic antibiotics are generally indicated for moderate or severeacne. The most commonly used systemic antibiotics are tetracycline andtheir derivatives (e.g., minocycline). These agents haveanti-inflammatory properties and they are effective against P. acnes.The more lipophilic antibiotics, such as minocycline and doxycycline,are generally more effective than tetracycline. Greater efficacy mayalso be due to less P. acnes resistance to minocycline.

Oral tetracycline antibiotics are generally not recommended in thetreatment of minor mild acne, primarily because they causehyper-pigmentation, erythema and dryness. Oral tetracycline therapy mayinduce hyperpigmentation in many organs, including nails, bone, skin,eyes, thyroid, visceral tissue, oral cavity (teeth, mucosa, alveolarbone), sclerae and heart valves. Skin and oral pigmentation have beenreported to occur independently of time or amount of drugadministration, whereas other tissue pigmentation has been reported tooccur upon prolonged administration. Skin pigmentation includes diffusepigmentation as well as over sites of scars or injury. Oraltetracyclines should not be used for pregnant women or nursing mothersdue to teratogenic effects. Accordingly, there exists a need for topicalformulations with tetracyclines which can avoid the side effectsobserved with oral applications.

For example, SOLODYN®, a commercially available product, is indicated totreat only inflammatory lesions of non-nodular moderate to severe acnevulgaris in patients 12 years of age or older. Adverse side effects fromthe use of SOLODYN® include, inter alia, diarrhea, dizziness,lightheadedness, and nausea, in addition to allergic reactions, bloodystool, blurred vision, rectal or genital irritation, and red, swollen,blistered, or peeling skin. Because of these side effects, the Food andDrug Administration added oral minocycline to its Adverse EventReporting System (AERS), a list of medications under investigation bythe FDA for potential safety issues.

Thus, a product that requires a shorter treatment period, has no orfewer adverse effects, does not cause or causes less skin irritation,and treats both inflammatory and non-inflammatory lesions would beadvantageous and could improve patient compliance. There also exists aneed for improved compositions and methods for treating rosacea, as wellas acne. Provided herein are compositions and methods to address thoseneeds.

SUMMARY

In one aspect, provided is a method for treating rosacea or acne in asubject in need thereof, the method comprising: administering to saidsubject a topical composition comprising an effective amount of atetracycline antibiotic.

In another aspect, provided is a hydrophobic gel or foam compositioncomprising: a tetracycline antibiotic, wherein said tetracyclineantibiotic is present in said gel or foam composition in an amounteffective to treat rosacea or acne in a subject.

In an exemplary embodiment, the gel or foam composition provided hereinfurther comprises at least one hydrophobic solvent, at least oneviscosity-modifying agent, or a combination thereof. In someembodiments, the composition comprises silicon dioxide (SiO₂).

In a particular embodiment, the tetracycline antibiotic is minocyclinehydrochloride or doxycycline hyclate, or a combination thereof.

In yet another aspect, provided is a method of manufacturing a gel orfoam composition having a tetracycline antibiotic, the methodcomprising: providing a composition having one or more hydrophobicsolvents; heating said composition; adding fatty alcohols, fatty acids,and waxes; cooling said composition; adding SiO₂; and addingtetracycline antibiotic.

In a further aspect, provided is a method for treating rosacea or acnein a subject in need thereof, the method comprising: administering tosaid subject a topical composition comprising an effective amount of atetracycline antibiotic, wherein said tetracycline antibiotic isminocycline.

In a yet further aspect, provided is a hydrophobic foam or gelcomposition comprising: about 50% by weight of soybean oil; about 23.6%by weight of coconut oil; about 5% by weight of cyclomethicone; about2.8 to 4.3% by weight of light mineral oil; about 3.5% by weight ofcetostearyl alcohol; about 3% by weight of stearic acid; about 2.5% byweight of myristyl alcohol; about 2% by weight of hydrogenated castoroil; about 2% by weight of beeswax; about 1.5% by weight of stearylalcohol; about 1.1% by weight of behenyl alcohol; and about 1.5 to 3% byweight of minocycline.

In an additional aspect, provided is a method for treating a rosacea ina subject in need thereof, the method comprising: administering to saidsubject a hydrophobic foam or gel composition comprising about 50% byweight of soybean oil; about 23.6% by weight of coconut oil; about 5% byweight of cyclomethicone; about 2.8 to 4.3% by weight of light mineraloil; about 3.5% by weight of cetostearyl alcohol; about 3% by weight ofstearic acid; about 2.5% by weight of myristyl alcohol; about 2% byweight of hydrogenated castor oil; about 2% by weight of beeswax; about1.5% by weight of stearyl alcohol; about 1.1% by weight of behenylalcohol; and about 1.5 to 3% by weight of minocycline.

In an additional aspect, provided is a method for reducing papules andpustules in a subject in need thereof, the method comprising:administering to said subject a topical composition comprising aneffective amount of a tetracycline antibiotic to treat, ameliorate,reduce, or cure acne or rosacea.

In an additional aspect, provided is a method for reducing skin lesionin a subject in need thereof, the method comprising: administering tosaid subject a topical composition comprising an effective amount of atetracycline antibiotic.

In an additional aspect, provided is a method for reducing skin rednessin a subject in need thereof, the method comprising: administering tosaid subject a topical composition comprising an effective amount of atetracycline antibiotic.

In an additional aspect, provided is a method for treating erythema in asubject in need thereof, the method comprising: administering to saidsubject a topical composition comprising an effective amount of atetracycline antibiotic.

In an additional aspect, provided is a method for treating a rosacea ina subject in need thereof, the method comprising: administering to saidsubject a placebo topical composition, wherein said composition is freeof a tetracycline antibiotic.

In an additional aspect, provided is a method for reducing papules andpustules in a subject in need thereof, the method comprising:administering to said subject a placebo topical composition, whereinsaid composition is free of a tetracycline antibiotic.

In an additional aspect, provided is a method for reducing skin lesionsin a subject in need thereof, the method comprising: administering tosaid subject a placebo topical composition, wherein said composition isfree of a tetracycline antibiotic.

In an additional aspect, provided is a method for reducing skin rednessin a subject in need thereof, the method comprising: administering tosaid subject a placebo topical composition, wherein said composition isfree of a tetracycline antibiotic.

In an additional aspect, provided is a method for treating erythema in asubject in need thereof, the method comprising: administering to saidsubject a placebo topical composition, wherein said composition is freeof a tetracycline antibiotic.

Other features and advantages of the compositions and methods willbecome apparent from the following detailed description examples andfigures. It should be understood, however, that the detailed descriptionand the specific examples, while indicating preferred embodiments, aregiven by way of illustration only, since various changes andmodifications within the spirit and scope of the disclosure will becomeapparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE FIGURES

The disclosure will be better understood from a reading of the followingdetailed description taken in conjunction with the drawings below:

FIG. 1A-FIG. 1B show significant decrease in the number of papules andpustules after treatment with a 1.5% and 3% minocycline foam.Specifically, FIG. 1A shows absolute change in papules and pustules,while FIG. 1B shows percent reduction in papules and pustules.

FIG. 2A-FIG. 2B show investigator's global assessment (IGA) results.FIG. 2A shows subjects with IGA improvement ≥2 grades and FIG. 2B showssubjects with IGA improvement of at least two grades which resulted inclear (0) to almost clear (1) score.

FIG. 3 shows clinical erythema assessment change from the baseline after12 weeks of treatment.

FIG. 4A-FIG. 4B show mean plasma minocycline concentration vs timeprofiles following a single oral dose of minocycline during Period 1(FIG. 4A) and topical application of minocycline foam 4% daily for 21days during Period 2 (FIG. 4B). FIG. 4 C shows comparison of mean plasmaminocycline concentration over the first 24 hours after oral minocyclinedose or topical minocycline foam 4% administration over the 24 hours atday 1, day 12 and day 21. Graphs are shown with semi-log scale.

FIG. 5 shows mean plasma minocycline pre-dose concentration-vs-timeprofile for topical minocycline foam 4% from day 1 through day 21(linear scale).

FIG. 6 shows changes in RosaQoL (Rosacea Quality of Life) index score atWeek 12 of treatment with two doses of FMX103 (1.5% and 3%) and vehiclefoam as compared to baseline (prior to treatment).

DETAILED DESCRIPTION

Provided herein are compositions and methods for treating rosacea.Specifically, provided herein are gel and foam compositions having atetracycline antibiotic and uses thereof for treating rosacea and/oracne.

The method provided herein includes administering topically to a surfacehaving the disorder a therapeutic hydrophobic composition comprising atetracycline antibiotic. In one or more embodiments, the hydrophobiccomposition comprises a carrier comprising about 60% to about 99% byweight of at least one hydrophobic solvent; at least oneviscosity-modifying agent selected from the group consisting of a fattyalcohol, a fatty acid and a wax; and a tetracycline antibiotic. In someembodiments, the composition comprises silicon dioxide (SiO₂).

Further provided herein is a method of treating human skin disorderssuch as rosacea or rosacea related diseases or disorders by topicalapplication of a foam or gel or liquid gel as described herein to apatient in need thereof.

According to one or more embodiments provided herein, the tetracyclineis a minocycline or doxycycline, which are semi-synthetic tetracyclineantibiotic. In a particular embodiment, the tetracycline is minocycline.The tetracycline drug is usually bacteriostatic in action. It can, amongother options, exert its antimicrobial activity by inhibiting proteinsynthesis. It can also have an antiviral effect. According to one ormore embodiments, the minocycline is minocycline hydrochloride(minocycline HCl; hereinafter “MCH”). MCH is a yellow crystalline powderthat is sparingly soluble in water, slightly soluble in alcohol andpractically insoluble in chloroform and in ether.

Minocycline is known to be highly sensitive to air and light andundergoes rapid degradation. Therefore, storage of foamable formulationsin airtight sealed containers under pressure with propellant cancontribute to preserving stability subject to selection of compatiblecanisters and accessories. Likewise, production and/or filling undervacuum in an oxygen free environment can help.

The ingredients of the carrier are selected for their compatibility withtetracycline antibiotics as described. Since it is not sufficient toidentify single ingredients that are compatible with tetracyclineantibiotics, formulations had to be found in which the ingredients incombination were also compatible with tetracycline antibiotics.

The hydrophobic foamable composition (e.g., foam or gel) provided hereincomprises: a) about 60% to about 99% by weight of at least onehydrophobic solvent; b) about 1% to about 22% by weight of at least oneviscosity modifying agent; and c) about 0.1% to about 18% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline).

The hydrophobic foamable composition or gel provided herein comprises:a) about 70% to about 90% by weight of at least one hydrophobic solvent;b) about 10 to about 22% by weight of at least one viscosity modifyingagent; and c) about 0.5% to about 8% of a tetracycline antibiotic (e.g.,minocycline HCl or doxycycline).

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 75% to about 90% by weight of atleast one hydrophobic solvent; b) about 10 to about 22% by weight of atleast one viscosity modifying agent; and c) about 1% to about 4% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline).

The hydrophobic foamable composition or gel provided herein comprises:a) about 72% to about 88% by weight of at least one hydrophobic solvent;b) about 10 to about 22% by weight of at least one viscosity modifyingagent; and c) about 2% to about 6% of a tetracycline antibiotic (e.g.,minocycline HCl or doxycycline).

According to one or more embodiments, there are provided substantiallysurfactant-free oleaginous formulations comprising a tetracycline, suchas a minocycline, for use in treatment of a rosacea disease, and/or acnerelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and other superficialinfections, including skin infections. In one or more embodiments thetetracycline acts to reduce oxidative stress and/or inflammation in skinpathologies. In one or more embodiments the tetracycline is effectivewhere the condition is accompanied by apoptotic cell death.

In one or more embodiments, the tetracycline is minocycline HCl at aconcentration of about 1.5% or about 3%, or any concentration inbetween.

Definitions

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as is commonly understood by one of ordinary skillin the art to which this disclosure belongs. All ranges disclosed hereininclude the endpoints. The use of the term “or” shall be construed tomean “and/or” unless the specific context indicates otherwise. Allpatents, applications, published applications, and other publicationsare incorporated by reference in their entirety. In the event that thereis a plurality of definitions for a term herein, those in this sectionprevail unless stated otherwise.

All % values are provided on a weight (w/w) basis.

Various carriers and compositions or formulations are described herein.They are often described for use in a method. A reference to or exampleof a carrier, composition or formulation for use in one method does notin any way limit the carrier, composition or formulation for use just inthat method, but it can be for use in any other method or embodimentdescribed herein. The carriers, compositions or formulations describedherein are in one or more embodiments provided as carriers, compositionsor formulations and are in one or more embodiments provided as a producteven where they are described only in relation to their use in a method.

As used herein, the term “about” has its usual meaning in the context ofpharmaceutical and cosmetic formulations to allow for reasonablevariations in amounts that can achieve the same effect. By the term“about” herein it is meant as indicated above and also that a figure orrange of figures can vary in an embodiment plus or minus up to 30%. Forexample, if an amount of “about 1” is provided, then the amount can beup to 1.3 or from 0.70. In other embodiments, it can reflect a variationof plus or minus 20%, in which case “about 2” can reflect a variation of1.6 to 2.4. In still further embodiments, it can describe a variation ofplus or minus 10%, in which case “about 1” can reflect a variation of0.9 to 1.1. In still further embodiments, it can describe a variation ofplus or minus 5%, in which case “about 5” can reflect a variation of4.75 to 5.25. In cases where “about X” will lead to a figure of above100%, the term in one or more embodiments can be read as reflecting upto 100% by weight less the total of the minimum amount of the otheringredients. Likewise, it will be appreciated by one skilled in the artto the extent X is reduced from that upper level the amounts of theother ingredients are increased appropriately. As will be appreciated byone of skill in the art, there is some reasonable flexibility informulating compositions such that where one or more ingredients arevaried, successful formulations can still be made even if an amountfalls slightly outside the range. Therefore, to allow for thispossibility, amounts are qualified by about. In one or more otherembodiments, the figures can be read without the term “about.”

As used herein, the terms “composition(s)” and “formulation(s)” can beused interchangeably depending on the context in which they are used aswould be appreciated by a person skilled in the art.

The term “room temperature” as used herein, means 20° C. to 25° C. In anembodiment it is 20° C. In an embodiment it is 21° C. In an embodimentit is 22° C. In an embodiment it is 23° C. In an embodiment it is 24° C.In an embodiment it is 25° C.

The term “thixotropic,” as used herein, means that the formulation showsa decrease in viscosity upon application of shear force. The structureof the formulation breaks down, leading to a reduction in viscosity.When the formulation is standing without shear force, this decrease inviscosity is recovered over time.

As used herein, the term “gel” means a jelly-like material that can haveproperties ranging from soft and fluid to hard and tough. Gels can be ina liquid, a semi-liquid, a semi-solid or a solid state. Solid gels aredefined as a substantially diluted cross-linked system, which exhibitsno flow when in the steady-state. By weight, gels are mostly liquid, yetthey behave like semi-solids due to a three-dimensional cross-linkednetwork of a solidifying, gelling or thickening agent within the liquid.It is the crosslinks within the fluid that give a gel its structure(hardness) and contribute to stickiness (tack). Depending on the amountsof gelling agent in a formulation, the gel can be semi-solid with somelimited flowability, such that when the semi-solid gel is placed in atube and is inclined horizontally from a vertical position it willslowly flow from the vertical towards the horizontal or it can be aliquid gel where the amount of gelling agent or gelling effect is lower,such that the gel structure or connections are weaker or loose so thatwhen placed in a tube and tilted from a vertical position to ahorizontal position, the gel readily flows and adapts to the horizontalposition. The rheological properties of gels at different surfacetemperatures can influence the release and bioabsorption of drugstherefrom.

The term “liquid gel” refers, inter alia, to a formulation afterpropellant is added (whereas, prior to adding the propellant, theformulation is a gel), or where the gel is loose or fluid or such thatwhen subjected to gravity, it will pour or become liquid.

The terms “waterless” or “water-free” as used herein, mean that thecomposition contains no free or unassociated or absorbed water. Theterms “substantially water-free” or “substantially waterless” refer tocarriers that contain at most incidental or trace amounts of water. Asused herein, “low water” means the composition contains about or lessthan 1% by weight; about or less than 0.9% by weight; about or less than0.8% by weight; about or less than 0.7% by weight; or about or less than0.6% by weight. As used herein, “substantially waterless” or“substantially water free” means the composition contains about or lessthan 0.5% by weight; about or less than 0.4% by weight; about or lessthan 0.3% by weight; about or less than 0.2% by weight; or about or lessthan 0.1% by weight. In one or more embodiments, the composition is“essentially water-free,” meaning about or less than 0.05% by weight; orabout or less than 0.01% water is present in the composition, by weight.

By the term “single phase” it is meant that after addition of propellantto the composition or carrier, the liquid components of the foamablecomposition or carrier are fully miscible, and the solid components, ifany, are either dissolved or homogeneously suspended in the compositionso that only one phase is visible.

By the term “substantially a single phase” it is meant that thecomposition or carrier, after addition of propellant, is primarily oressentially a single phase as explained above, but can also have presenta small amount of material which is capable of forming a separate phaseamounting to less than about 5% by weight of the composition or carrierafter the addition of propellant, or less than about 3% by weight,and/or less than about 1% by weight of the composition.

The term “unstable” as used herein, means a compound, e.g., an activeagent, which is oxidized and/or degraded within less than a day, and insome cases, in less than an hour, upon exposure to air, light, skin, orwater or a pharmaceutical excipient under ambient conditions.

The term “unstable active agent” as used herein, means an active agentwhich is oxidized and/or degraded within less than a day, and in somecases, in less than an hour upon exposure to air, light, skin, water, ora pharmaceutical excipient under ambient conditions.

It should be noted that the terms “surfactant,” “surface active agent,”and “emulsifier” in the context used herein, refer to stand alonecompounds used to reduce surface tension between two substances orphases, and which are also capable of stabilizing an emulsion of waterand oil. Reduction of surface tension can be significant in foamtechnology in relation to the ability to create small stable bubbles.“Surfactant” and “emulsifier,” as used herein, do not include compoundswhich do not function effectively as standalone compounds for reducingsurface tension between two substances or phases and which are notcapable of stabilizing an emulsion of water and oil. For example, asurfactant or emulsifier as provided herein does not include fattyacids, does not include fatty alcohols, and does not includepropoxylated lanolin oil derivatives. In the context of the presentdisclosure, fatty acids and fatty alcohols are defined as foamadjuvants. Similarly, propoxylated lanolin oil derivatives in thecontext herein are defined as emollients.

“Standard surfactant,” “customary surfactant” or “stand alonesurfactant” refer to customary non-ionic, ionic, anionic, cationic,zwitterionic, amphoteric and amphiphilic surfactants. Many standardsurfactants are derivatives of fatty alcohols or fatty acids, such asethers or esters formed from such fatty alcohols or fatty acids withhydrophilic moieties, such as polyethylene glycol (PEG). However, anative (non-derivatized) fatty alcohol or fatty acid, as well as waxesare not regarded as a standard surfactant.

The term “co-surfactant” as used herein means a molecule which on itsown is not able to form and stabilize satisfactorily an oil-in-wateremulsion, but when used in combination with a surfactant as definedherein, the co-surfactant has properties which can allow it to help asurfactant create an emulsion and can boost the stabilizing power oreffect of the surfactant. Examples of co-surfactants include fattyalcohols, such as cetyl alcohol, or fatty acids, such as stearic acid.Cetyl alcohol is a waxy hydrophobic substance that can be emulsifiedwith water using a surfactant. Some substances can have more than onefunction and for example, fatty alcohols can in some formulations act asa co-solvent. In certain circumstances, a co-surfactant can itself beconverted into a surfactant or soap by, for example, adding a base, suchas, triethanolamine to a fatty acid like stearic acid.

The term “viscosity-modifying agent” in the context of the presentdisclosure is an agent which, when added to a hydrophobic oil,facilitates the creation of a hydrophobic breakable vehicle in the formof a breakable gel or breakable foam. According to the presentdisclosure, the viscosity-modifying agent is a “foamer complex,” whichis also referred as a “foam stabilizer” in this application, comprisinga fatty alcohol, a fatty acid and/or a wax. In one or more alternativeembodiments the foamer complex is a fatty alcohol and a wax or a fattyacid and a wax. In some embodiments it is a wax. In one or moreembodiments the foamer complex or viscosity modifying agent comprises atleast one of a fatty alcohol, a wax or a fatty acid. In one or moreembodiments the foamer complex or viscosity modifying agent is selectedfrom a group consisting of a fatty alcohol, a wax and a fatty acid. Insome embodiments, it is a fatty alcohol. In some embodiments, it is afatty acid. In some embodiments a fatty alcohol, and/or a fatty acidand/or a wax is an adjuvant. In the context of the present disclosurefatty alcohols, fatty acids and waxes that are compatible withtetracycline antibiotics, and in particular with a minocycline or adoxycycline, are compatible adjuvants.

The term “breakable” refers to a property of a gel or foam wherein thegel or foam is stable upon dispensing from a container, yet breaks andspreads easily upon application of shear or mechanical force, which canbe mild, such as a simple rub.

The term “water activity” as used herein represents the hygroscopicnature of a substance, or the tendency of a substance to absorb waterfrom its surroundings. Microorganisms require water to grow andreproduce, and such water requirements are best defined in terms ofwater activity of the substrate. The water activity of a solution isexpressed as Aw=P/Po, where P is the water vapor pressure of thesolution and Po is the vapor pressure of pure water at the sametemperature. Every microorganism has a limiting Aw, below which it willnot grow; e.g., for Streptococci, Klebsiella spp, Escherichia coli,Clostridium perfringens, and Pseudomonas spp, the Aw value is 0.95.Staphylococcus aureus is most resistant and can proliferate with an Awas low as 0.86, and fungi can survive at an Aw of at least 0.7. Theidentification of a “solvent,” as used herein, is not intended tocharacterize the solubilization capabilities of the solvent for anyspecific active agent or any other component of the foamablecomposition. Rather, such information is provided to aid in theidentification of materials suitable for use as a component of thefoamable composition described herein.

As used herein, the term “preventing” refers to avoiding the onset of adisorder or condition from occurring in a subject that has not yet beendiagnosed as having the disorder or condition, but who may besusceptible to it.

As used herein, the term “treatment” refers to inhibiting the disorderor condition, i.e., arresting its development; relieving the disorder orcondition, i.e., causing regression of the disorder or condition orreversing the progression of the disorder or condition; or relieving orreducing one or more symptoms of the disorder or condition.

It should be noted that the term “a method of preventing, treating adisease or a disorder” as provided throughout the specification isinterchangeable with the term “use of the composition as a medicamentfor preventing or treating a disease.” It should be noted that the term“disease” is used interchangeably with the term “disorder.”

It should be noted that the term “substantially free of” an ingredientas provided throughout the specification is intended to mean that thecomposition comprises less than about 0.5% by weight, e.g., less thanabout 0.4% by weight, less than about 0.3% by weight, less than about0.2% by weight, or less than about 0.1% by weight, of an ingredientunless specifically indicated otherwise.

As used herein, the term “essentially free of” an ingredient as providedthroughout the specification is intended to mean that the compositioncomprises less than about 0.05% by weight, less than about 0.01% byweight, less than about 0.001% by weight, or 0% by weight, orinsignificant or negligible amounts of the ingredient, unlessspecifically indicated otherwise.

As used herein, the term “free of” an ingredient as provided throughoutthe specification is intended to mean that the composition does notcomprise any amount of the ingredient, unless specifically indicatedotherwise.

The terms “surfactant-free” or “emulsifier-free” or “non-surfactant”refer to compositions which comprise no or negligible levels ofsurfactants, emulsifiers, or surface active agents. Where a formulationincludes insignificant or de minimis amounts of surfactants,emulsifiers, or surface active agents it is considered to be essentiallysurfactant-free. As used herein, “essentially free” indicates less thanabout 0.05% by weight, less than about 0.01% by weight, less than about0.001% by weight, or 0% by weight of a surfactant selected from thegroup consisting of customary non-ionic, ionic, anionic, cationic,zwitterionic, amphoteric and ampholytic surfactants.

The term “substantially surfactant-free” relates to a compositionwherein the ratio between the viscosity-modifying agent and thesurfactant is between 10:1 or 5:1; or between 20:1 and 10:1 or between100:1 and 20:1. In additional embodiments, the term relates to acomposition that contains a total of about or less than 0.5% by weight;about or less than 0.4% by weight; or about or less than 0.3% by weightof a surfactant selected from the group consisting of customarynon-ionic, ionic, anionic, cationic, zwitterionic, amphoteric andampholytic surfactants. In some embodiments, the composition comprisesabout or less than 0.2% by weight of a standard or customary surfactant;about or less than 0.15% by weight; about or less than 0.1% by weight;about or less than 0.05% by weight; or about or less than 0.01% byweight.

By “de minimis” it is meant to be so minor that its effect is to bedisregarded.

The terms “hydrophobic gel composition” or “hydrophobic foamcomposition” or “hydrophobic composition” are intended to mean that thecomposition has a low solubility in water. In one embodiment, 100 to1000 parts of water are needed to dissolve or render miscible 1 part ofthe composition. In another embodiment, 1000 to 10,000 parts of waterare needed to dissolve or render miscible 1 part of the composition. Inyet another embodiment, more than 10,000 parts of water are needed todissolve or render miscible 1 part of the composition.

The term “clinical response to treatment”, (“clinical success” or“clinical failure”) in the context of rosacea treatment is derived fromefficacy evaluation endpoints. The term “lesion count” relates to thenumber of inflammatory lesions (e.g., papules and pustules) present in adesignated area of the body (e.g., in case of face, on the forehead,left and right cheeks, nose and chin).

The terms “high rates of clinical response” or “high efficacy” or“substantial decrease” in the context herein can relate to an absolutechange in inflammatory lesion count of at least 19 compared to baseline,a reduction of about 45% or more in inflammatory lesions count or towhere subjects met a success criterion of “clear” or “almost clear” orto an “improvement of 2 grades from the baseline”; or to where subjectsreceive an excellent score according to Investigator's GlobalImprovement Assessment; or to where patients receive a two step drop inPatient's Global Improvement Assessment (IGA) score; or whereinaccording to any of the aforementioned endpoints a statisticallysignificant reduction or improvement is demonstrated as compared toplacebo.

By “regular basis” it is meant a repeated or repeatable interval of timewhich can be by way of illustration, a part of a day, daily, once daily,twice daily, alternative daily, alternate daily, twice weekly, triceweekly, weekly, fortnightly, monthly or some other repeated orrepeatable interval for an appropriate period of time wherein a dose isto be applied. The repeated applications can be determined according tothe needs of the subject and the disease or disorder. In somecircumstances as little as three repeat doses can be required. In othercases, between 3 and 14, in other cases between 14 and 28, in othercases between 28 and 50, in other cases between 50 and 75, in othercases between 75 and 100, and in other cases, such as where prolongedtreatment or a long period of maintenance dosing is needed, as many asone, two, or three hundred repeat doses can be needed.

The term “adverse events” describes any unfavorable or unintended sign,symptom, or disease that appears or worsens in a subject after thesubject has commenced using the formulation. Examples of what can beconsidered an adverse event (AE) include any of the following: A newillness, an exacerbation of a sign or symptom of an underlying conditionor of a concomitant illness unrelated to participation in the clinicalstudy, a sign or symptom as an effect of the study drug or comparatordrug The common term for such problems is “side effects,” and used bypatients and physicians.

The term “serious adverse events” describes any adverse effect that:Results in death, is life-threatening (Note: The term “life-threatening”refers to any adverse event that, as it occurs, puts the subject atimmediate risk of death. It does not refer to an adverse event thathypothetically might have caused death if it were more severe.), resultsin hospitalization or prolongation of current hospitalization (notincluding hospitalization for a pre-existing condition that has notincreased in severity or frequency from the subject's underlying medicalcondition prior to entry into the study), results in persistent orsignificant disability/incapacity, is a congenital anomaly/birth defectin the offspring of a subject, is an important medical event (Note:Important medical events may not be immediately life-threatening orresult in death or hospitalization but may be considered serious when,based upon appropriate medical judgment, they may jeopardize the subjector require medical or surgical intervention to prevent one of theoutcomes listed above. Examples of such medical events include allergicbronchospasm requiring intensive treatment in an emergency room or athome; blood dyscrasias or convulsions that do not result in inpatienthospitalization; or development of drug dependency or drug abuse.)

The term “safe” in the context herein means having no or essentially noadverse events (e.g., any unfavorable or unintended sign, symptom, ordisease that appears or worsens on the course of treatment).

It should be noted that the term “polyol” as used herein is an organicsubstance that contains at least two hydroxyl groups in its molecularstructure.

The terms “local safety” or “tolerable” or “enhanced tolerability” inthe context herein means having no or essentially no skin irritationsymptoms such as telangiectasis, burning or stinging, flushing orblushing, or alternatively, when such symptoms arise they are mild anddisappear without interrupting treatment. The score for such symptoms ismeasured by the investigator at baseline, 2, 4, 8, and 12 weeks and isaccording to a scale of none, mild, moderate and severe. The scorerepresents the subject's condition at the time of evaluation. The scorefor burning or stinging and flushing or blushing is based on thesubject's symptoms reported for the previous three days. These symptomsshould not be included as adverse events, unless a symptom is believedto have been related to the study medication or is the reason fordiscontinuation from the study.

By “essentially no” in the context of tolerability includesinsignificant or de minimis occurrences of skin irritation eventsmanifested in symptoms such as telangiectasis, burning or stinging,flushing or blushing, or mild transient events connected with theapplication of topical tetracyclines or vehicle.

By “essentially no” in the context of safety includes insignificant orde minimis occurrences of systemic or serious adverse events connectedwith the application of topical tetracyclines or vehicle.

The clinical response was determined at each study visit inter alia byan absolute inflammatory lesion count, by % change in inflammatorylesion count, by Investigator global assessment, by improvementassessment (by the Investigator) and improvement assessment (by thepatient). Photographs were also used to assess the clinical improvement.The improvement assessment by the investigator includes scoring rosaceaseverity based on the number of inflammatory lesions and level oferythema. The improvement assessment by the patient involves measuringthe health-related quality of life of patients through Rosacea Qualityof Life (RosaQoL), a self-administered questionnaire.

The term clinical failure is defined as insufficient improvement ordeterioration (i.e., an increase or no change in the number of lesions).

By “on average,” with reference to dosage regimes, it is intended toreflect and/or take into account human nature and that a subject mayforget to apply a dose or not strictly adhere to the regime, such thateven if a subject forgets a dose or does not strictly adhere to theregime it will still be considered as if the regime has been applied.For example, if a subject misses an occasional dose but does not make itup, or alternatively, if having missed a dose applies a compensatorydose on a different day, it is still counted as having complied with thedosage regime.

Compositions

Gel or foam compositions having tetracycline antibiotic are well-knownin the art and fully described in U.S. Patent Application PublicationNos. 2014/0121188 and 2013/0225536, which are herein incorporated byreference in their entirety.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a tetracycline antibiotic for use in treating arosacea in a human subject suffering therefrom comprising topicallyadministering the composition to the human subject in a sufficientamount and for a sufficient time to decrease the number of rosacealesions.

Tetracycline Antibiotic

Any tetracycline antibiotic known to one of skilled in the art can beused. Examples of a tetracycline antibiotic include, for example, butnot limited to tetracycline, oxytetracycline, demeclocycline,doxycycline, lymecycline, meclocycline, methacycline, minocycline,rolitetracycline, chlorotetracycline, and tigecycline.

In a particular example, the tetracycline is a minocycline ordoxycycline, which are semi-synthetic tetracycline antibiotic. Accordingto one or more embodiments, the tetracycline is minocycline. Thetetracycline drug is usually bacteriostatic in action. It can, amongstother options, exert its antimicrobial activity by inhibiting proteinsynthesis. It can also have an antiviral effect. According to one ormore embodiments, the minocycline is minocycline hydrochloride(minocycline HCl; (hereinafter “MCH”)). In some embodiments, MCH is ayellow crystalline powder that is sparingly soluble in water, slightlysoluble in alcohol and practically insoluble in chloroform and in ether.

Minocycline and MCH is known to be highly sensitive to air and light andundergoes rapid degradation. Therefore, storage of foamable formulationsin airtight sealed containers under pressure with propellant cancontribute to preserving stability, subject to selection of compatiblecanisters and accessories. Likewise, production and/or filing undervacuum in an oxygen free environment can help.

Thus, it was unexpectedly demonstrated that topical minocycline foamoffered a safe and effective alternative to topical compositionscontaining for example, ivermectin, metronidazole, azelaic acid andbrimonidine tartrate for the topical treatment of rosacea. The ease ofuse, with once daily dosing, as well as its broad spectrum of activity,early onset, the low level of adverse events and the rapid reduction inthe number of lesions make it an attractive choice and a potentiallyvaluable medication for the treatment of acute bacterial skininfections.

Examples of bacterial infections that can be effectively treated bytopical tetracycline antibiotics include, but not limited to,cellulitis, acute lymphangitis, lymphadenitis, erysipelas, cutaneousabscesses, necrotizing subcutaneous infections, staphylococcal scaldedskin syndrome, folliculitis, furuncles, hidradenitis suppurativa,carbuncles, paronychial infections, erythrasma, disorders of hairfollicles and sebaceous glands, acne, impetigo, rosacea, perioraldermatitis, hypertrichosis (hirsutism), alopecia, including male patternbaldness, alopecia greata, alopecia universalis and alopecia totalis,pseudofolliculitis barbae, and keratinous cyst. For example, rosaceainvolves papules and pustules, which can be treated with an antibioticagent, as well as erythema, telangiectasia, and redness, which partiallyrespond to treatment with an antibiotic agent.

In one or more embodiments, the active agent can be a placebo or acosmetic agent. The foamable composition is suitable for use in themanufacture of a medicament including a placebo or active agent.

In one or more embodiments, the tetracycline antibiotic is hydrophobic.

In one or more embodiments, the Log of the distribution constant of thetetracycline antibiotic at pH 7.0 (buffer/chloroform) is equal to orless than about 0.2.

In one or more embodiments, tetracycline antibiotic forms suitable foruse according to the methods and compositions of the present disclosureinclude, but are not limited to, a free base form, a hydrate form, asalt form, a chelate complex form or a coordination complex form.

In one or more embodiments, the tetracycline antibiotic does notcomprise a hydroxyl group at carbons 5, 6, and 7.

In one or more embodiments, the tetracycline antibiotic comprises or isselected from the group consisting of minocycline and doxycycline. Insome embodiments, the tetracycline antibiotic is minocycline. In someembodiments, the concentration of minocycline is in a range betweenabout 0.1% to about 10% by weight (e.g., about 0.1% to about 8% byweight, about 0.1% to about 5% by weight, about 0.1% to about 3% byweight, about 0.1% to about 2% by weight, about 0.1% to about 1% byweight, about 0.1% to about 0.75% by weight, about 0.1% to about 0.5% byweight, about 0.1% to about 0.25% by weight, about 0.25% to about 10% byweight, about 0.5% to about 10% by weight, about 0.5% to about 5% byweight, about 0.5% to about 4% by weight, about 0.5% to about 3% byweight, about 1% to about 10% by weight, about 2% to about 10% byweight, about 4% to about 10% by weight, about 6% to about 10% byweight, about 7% to about 10% by weight, about 8% to about 10% byweight, about 0.5% to about 2.0% by weight, about 0.75% to about 1.5% byweight, about 1% to about 3% by weight, about 1% to about 4% by weight,and about 2% to about 6% by weight). In some embodiments, theconcentration of minocycline is at least about 0.05% by weight, is atleast about 0.1% by weight, at least about 0.5% by weight, at leastabout 1% by weight, at least about 2% by weight, at least about 4% byweight, at least about 6% by weight, at least about 8% by weight or atleast about 10% by weight.

In one or more embodiments, the minocycline is micronized.

In one or more embodiments, the initial dose of tetracycline is about18%, or about 17.5%, or about 16.5%, or about 15.5%, or about 14.5%, orabout 13.5% or about 12.5%, or about 11.5%, or about 10.5% or about 9.5%or about 8.5% or about 7.5% or about 6.5% or about 5.5% or about 4.5% orabout 3.5% or about 2.5% or about 1.5%, or about 17%, or about 16%, orabout 15%, or about 14%, or about 13% or about 12%, or about 11%, orabout 10% or about 9% or about 8% or about 7% or about 6% or about 5% orabout 4% or about 3% or about 2% or about 1% or about 0.75% or about0.5% or about 0.25% or about 0.2% by weight of the composition. In oneor more embodiments, the maintenance dose of tetracycline is about 7.5%or about 6.5% or about 5.5% or about 4.5% or about 3.5% or about 2.5% orabout 1.5%, 7% or about 6% or about 5% or about 4% or about 3% or about2% or about 1% or about 0.5%, or about 1.9%, or about 1.8%, or about1.7%, or about 1.6%, or about 1.55 or about 1.4% or about 1.3% or about1.2% or about 1.1%, or about 0.9% or about 0.8%, or about 0.7%, or about0.6% or about 0.4% or about 0.35 or about 0.25% or about 0.2% or about0.15% or about 0.1% by weight of the composition.

According to one or more embodiments, provided are substantiallysurfactant-free oleaginous formulations comprising a tetracycline, suchas a minocycline, for use in treatment of rosacea, and/or rosacearelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and/or a sebaceous glanddisorder. In one or more embodiments the tetracycline is used for thetreatment of rosacea. In one or more embodiments the tetracycline isused for the treatment of impetigo. In one or more embodiments thetetracycline is used for the treatment of acne. In one or moreembodiments the tetracycline acts to reduce oxidative stress and/orinflammation in skin pathologies. In one or more embodiments thetetracycline is effective where the condition is accompanied byapoptotic cell death.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a minocycline antibiotic for use in treating adisorder selected from the group consisting of rosacea, and/or rosacearelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and/or a sebaceous glanddisorder, wherein the hydrophobic gel or foam composition isadministered topically at least alternate days or at least once dailyfor at least two weeks to the skin, wherein the hydrophobic gel or foamcomposition is waterless and does not comprise a silicone other thancyclomethicone.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a minocycline antibiotic for use in treating adisorder selected from the group consisting of rosacea, and/or rosacearelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and/or a sebaceous glanddisorder, wherein the hydrophobic gel or foam composition isadministered topically at least alternate days or at least once dailyfor at least two weeks to the skin, mucosa, or eye, wherein thehydrophobic gel or foam composition is waterless and does not comprise apolyethylene gelling agent or polyethylene homopolymer or polyethylenecopolymer or a customary surfactant.

Foam Vehicle

It is postulated, without being bound by any theory, that the use of ahydrophobic oil based foam vehicle contributes to cutaneousbioavailability, including the achievement of therapeutic levels ofminocycline in the pilosebaceous unit. Specific targeting of hydrophobicoil based foam vehicle to the pilosebaceous unit is enabled due thehydrophobic nature of the pilosebaceous gland.

Thus, provided in various embodiments is a vehicle for delivering atherapeutically effective amount of active agent to the sebaceous glandor the sebaceous gland area or the pilosebaceous unit comprising: a)about 60% to about 99% by weight of at least one hydrophobic solvent; b)at least one viscosity-modifying agent, wherein said agent is a wax, afatty alcohol, a fatty acid, or mixtures of any two or more thereof.

Provided herein in various embodiments is a vehicle for delivering atherapeutically effective amount of active agent to the sebaceous glandor the sebaceous gland area or the pilosebaceous unit comprising: a)about 60% to about 99% by weight of at least one hydrophobic solvent; b)at least one viscosity-modifying agent comprising a wax and a fattyalcohol or a fatty acid, or both; wherein the active agent is atetracycline antibiotic.

Additionally, provided herein in various embodiments is a vehicle fordelivering a therapeutically effective amount of active agent to thesebaceous gland or the sebaceous gland area or the pilosebaceous unitcomprising: a) about 60% to about 99% by weight of at least onehydrophobic solvent; b) at least one viscosity-modifying agent, whereinsaid agent is a wax, a fatty alcohol, a fatty acid, or mixtures of anytwo or more thereof; wherein the active agent is a minocycline.

Hydrophobic Solvent

In certain embodiments, a hydrophobic solvent can be useful. Forexample, some essential oils can kill microorganisms or can prevent ofconditions that involve microbial infection. Additionally, hydrophobicsolvents can useful for the treatment of conditions which involvedamaged skin, such as psoriasis or atopic dermatitis. The combination ofa hydrophobic solvent and a fatty alcohol or fatty acid can be ofpossible help in conditions characterized, for example, by infectionand/or inflammation.

In one or more embodiments, the at least one hydrophobic solventcomprises or is selected from the group consisting of a mineral oil, ahydrocarbon oil, an ester oil, an ester of a dicarboxylic acid, atriglyceride oil, an oil of plant origin, an oil from animal origin, anunsaturated or polyunsaturated oil, a diglyceride, a PPG alkyl ether, anessential oil, a silicone oil, liquid paraffin, an isoparaffin, apolyalphaolefin, a polyolefin, polyisobutylene, a synthetic isoalkane,isohexadecane, isododecane, alkyl benzoate, alkyl octanoate, C12-C15alkyl benzoate, C12-C15 alkyl octanoate, arachidyl behenate, arachidylpropionate, benzyl laurate, benzyl myristate, benzyl palmitate,bis(octyldodecyl stearoyl)dimer dilinoleate, butyl myristate, butylstearate, cetearyl ethylhexanoate, cetearyl isononanoate, cetyl acetate,cetyl ethylhexanoate, cetyl lactate, cetyl myristate, cetyl octanoate,cetyl palmitate, cetyl ricinoleate, decyl oleate, diethyleneglycoldiethylhexanoate, diethyleneglycol dioctanoate, diethyleneglycoldiisononanoate, diethyleneglycol diisononanoate, diethylhexanoate,diethylhexyl adipate, diethylhexyl malate, diethylhexyl succinate,diisopropyl adipate, diisopropyl dimerate, diisopropyl sebacate,diisostearyl dimer dilinoleate, diisostearyl fumerate, dioctyl malate,dioctyl sebacate, dodecyl oleate, ethylhexyl palmitate, esterderivatives of lanolic acid, ethylhexyl cocoate, ethylhexylethylhexanoate, ethylhexyl hydroxystearate, ethylhexyl isononanoate,ethylhexyl palmitate, ethylhexyl pelargonate, ethylhexyl stearate,hexadecyl stearate, hexyl laurate, isoamyl laurate, isocetyl behenate,isocetyl lanolate, isocetyl palmitate, isocetyl stearate, isocetylsalicylate, isocetyl stearate, isocetyl stearoyl stearate, isocetearyloctanoate, isodecyl ethylhexanoate, isodecyl isononanoate, isodecyloleate, isononyl isononanoate, isodecyl oleate, isohexyl decanoate,isononyl octanoate, isopropyl isostearate, isopropyl lanolate, isopropyllaurate, isopropyl myristate, isopropyl palmitate, isopropyl stearate,isostearyl behenate, isostearyl citrate, isostearyl erucate, isostearylglycolate, isostearyl isononanoate, isostearyl isostearate, isostearyllactate, isostearyl linoleate, isostearyl linolenate, isostearyl malate,isostearyl neopentanoate, isostearyl palmitate, isostearyl salicylate,isostearyl tartrate, isotridecyl isononanoate, isotridecyl isononanoate,lauryl lactate, myristyl lactate, myristyl myristate, myristylneopentanoate, myristyl propionate, octyldodecyl myristate,neopentylglycol dicaprate, octyl dodecanol, octyl stearate, octylpalmitate, octyldodecyl behenate, octyldodecyl hydroxystearate,octyldodecyl myristate, octyldodecyl stearoyl stearate, oleyl erucate,oleyl lactate, oleyl oleate, propyl myristate, propylene glycol myristylether acetate, propylene glycol dicaprate, propylene glycol dicaprylate,propylene glycol dicaprylate, maleated soybean oil, stearyl caprate,stearyl heptanoate, stearyl propionate, tocopheryl acetate, tocopheryllinoleate, glyceryl oleate, tridecyl ethylhexanoate, tridecylisononanoate, triisocetyl citrate, alexandria laurel tree oil, avocadooil, apricot stone oil, barley oil, borage seed oil, calendula oil,cannelle nut tree oil, canola oil, caprylic/capric triglyceride castoroil, coconut oil, corn oil, cotton oil, cottonseed oil, evening primroseoil, flaxseed oil, groundnut oil, hazelnut oil, glycereth triacetate,glycerol triheptanoate, glyceryl trioctanoate, glyceryl triundecanoate,hempseed oil, jojoba oil, lucerne oil, maize germ oil, marrow oil,millet oil, neopentylglycol dicaprylate/dicaprate, olive oil, palm oil,passionflower oil, pentaerythrityl tetrastearate, poppy oil, propyleneglycol ricinoleate, rapeseed oil, rye oil, safflower oil, sesame oil,shea butter, soya oil, soybean oil, sweet almond oil, sunflower oil,sisymbrium oil, syzygium aromaticum oil, tea tree oil, walnut oil, wheatgerm glycerides, wheat germ oil, PPG-2 butyl ether, PPG-4 butyl ether,PPG-5 butyl ether, PPG-9 butyl ether, PPG-12 butyl ether, PPG-14 butylether, PPG-15 butyl ether, PPG-15 stearyl ether, PPG-16 butyl ether,PPG-17 butyl ether, PPG-18 butyl ether, PPG-20 butyl ether, PPG-22 butylether, PPG-24 butyl ether, PPG-26 butyl ether, PPG-30 butyl ether,PPG-33 butyl ether, PPG-40 butyl ether, PPG-52 butyl ether, PPG-53 butylether, PPG-10 cetyl ether, PPG-28 cetyl ether, PPG-30 cetyl ether,PPG-50 cetyl ether, PPG-30 isocetyl ether, PPG-4 lauryl ether, PPG-7lauryl ether, PPG-2 methyl ether, PPG-3 methyl ether, PPG-3 myristylether, PPG-4 myristyl ether, PPG-10 oleyl ether, PPG-20 oleyl ether,PPG-23 oleyl ether, PPG-30 oleyl ether, PPG-37 oleyl ether, PPG-40 butylether, PPG-50 oleyl ether, PPG-11 stearyl ether, herring oil, cod-liveroil, salmon oil, cyclomethicone, a dimethyl polysiloxane, dimethicone,an epoxy-modified silicone oil, a fatty acid-modified silicone oil, afluoro group-modified silicone oil, a methylphenylpolysiloxane, phenyltrimethicone and a polyether group-modified silicone oil or mixtures ofany two or more thereof. In some embodiments, the hydrophobic solventcomprises or is selected from the group consisting of soybean oil, acoconut oil, a cyclomethicone, a light mineral oil, and mixtures of anytwo or more thereof. In one or more embodiments the solvent is testedindividually for compatibility with a tetracycline antibiotic and isonly used if it passes a compatibility test as described below in theMethods.

As contemplated herein, the concentration of the hydrophobic solventand/or viscosity modifying agent in the composition is selected toprovide an Aw value selected from the ranges between or of (1) about 0.8and about 0.9; (2) about 0.7 and about 0.8; and (3) less than about 0.7.Delivering the formulation in a pressurized package does not allow forhumidity to be absorbed by the preparation, and therefore, the waterfree character of the composition is not altered or compromised.

In one embodiment, no preservative is needed in the formulationsprovided herein because the formulation is a waterless hydrophobicsolvent or oil-based formulation having an Aw (water activity) value ofless than 0.9, or less than about 0.8, or less than about 0.7, or lessthan about 0.6, and/or less than about 0.5, which is below the level ofmicrobial proliferation.

In one or more embodiments, the hydrophobic solvent is at aconcentration of about 75% to about 90% by weight. In one or moreembodiments, the hydrophobic solvent is at a concentration of at leastabout 40% by weight, at least about 50% by weight, at least about 60% byweight, at least about 70% by weight, at least about 90% by weight. Insome embodiments, the hydrophobic solvent is at a concentration of lessthan about 90% by weight, less than about 80% by weight, less than about70% by weight, less than about 60% by weight, less than about 50% byweight.

In some embodiments, the formulation can include a fatty alcohol. Longchain saturated and mono unsaturated fatty alcohols, e.g., stearylalcohol, erucyl alcohol, arachidyl alcohol and behenyl alcohol(docosanol) have been reported to possess antiviral, anti-infective, antproliferative and anti-inflammatory properties (see, U.S. Pat. No.4,874,794). Longer chain fatty alcohols, e.g., tetracosanol,hexacosanol, heptacosanol, octacosanol, triacontanol, etc., are alsoknown for their metabolism modifying properties, and tissue energizingproperties.

In one or more embodiments, the fatty alcohol and/or fatty acid have amelting point of at least about 40° C.

In one or more embodiments, the fatty alcohol comprises or is selectedfrom the group consisting of lauryl alcohol, myristyl alcohol, cetylalcohol, stearyl alcohol, cetostearyl, arachidyl alcohol, behenylalcohol, tetracosanol, hexacosanol, octacosanol, triacontanol, andtetratriacontanol or mixtures of any two or more thereof. In one or moreembodiments, the fatty acid comprises or is selected from the groupconsisting of dodecanoic acid, tetradecanoic acid, hexadecanoic acid,heptadecanoic acid, octadecanoic acid, eicosanoic acid, docosanoic acid,tetracosanoic acid, hexacosanoic acid, heptacosanoic acid, octacosanoicacid, triacontanoic acid, dotriacontanoic acid, tritriacontanoic acid,tetratriacontanoic acid, and pentatriacontanoic acid or mixtures of anytwo or more thereof.

In one or more embodiments, the carbon chain of the fatty alcohol or thefatty acid is substituted with a hydroxyl group.

In one or more embodiments, the fatty acid is 12-hydroxy stearic acid.

Viscosity-Modifying Agent

As contemplated herein, the gel is stable and it retains its viscosityupon dispensing from a container, such as a tube, yet, it liquefies andspreads easily upon application of shear force, which can be mild, suchas a simple rub. Further, while the gel is oily, it absorbs into thesite of application, such as the skin or mucosa membrane, and afterminutes the surface does not appear and/or feel significantly oily orgreasy.

In some embodiments, formulations comprising a hydrophobic oil andviscosity-modifying agents demonstrated increased viscosity of such oil,and to which when even small amounts of a suspended tetracyclineantibiotic were added, a substantial or synergistic increase in theviscosity of the composition was observed.

In one or more embodiments, the viscosity-modifying agent is a waxcomprising or selected from the group consisting of a plant wax,carnauba wax, candelilla wax, ouricury wax, sugarcane wax, retamo wax,jojoba oil, an animal waxes, beeswax, a hydrogenated castor oil, apetroleum derived wax, a paraffin wax, polyethylene, and derivativesthereof.

In one or more embodiments, the viscosity-modifying agent is acombination comprising (i) at least one fatty alcohol and at least onefatty acid; or (ii) at least one fatty alcohol and at least one wax; or(iii) at least one fatty acid and at least one wax; or (iv) at least onefatty alcohol, at least one fatty acid, and at least one wax.

In one or more embodiments the at least one viscosity-modifying agentcomprises or is selected from the group consisting of a fatty alcohol, afatty acid and a wax, wherein the fatty alcohols and/or fatty acids haveat least 12 carbon atoms in their carbon backbone. In certainembodiments the viscosity modifying agent is a combination of a fattyalcohol and a fatty acid and/or a wax.

In one or more embodiments, the viscosity-modifying agent is at aconcentration of about 0.1% to about 22%, about 0.4 to about 18%, about0.5% to 16%, about 0.6% to 14%, about 0.7% to 13%, about 0.8 to about12%, about 0.9% to about 11%, about 1% to about 10%, about 10% to about22% by weight. In one or more embodiments, the viscosity-modifying agentis a fatty alcohol having at least 12 carbon atoms in its carbonbackbone. In one or more embodiments, the viscosity-modifying agent is afatty acid having at least 12 carbon atoms in its carbon backbone.

In one or more embodiments, the viscosity-modifying agent is at aconcentration of about 9.5% or about 8.5% or about 7.5% or about 6.5% orabout 5.5% or about 4.5% or about 3.5% or about 2.5% or about 1.5%,about 7% or about 6% or about 5% or about 4% or about 3% or about 2% orabout 1% or about 0.5%, or about 1.9%, or about 1.8%, or about 1.7%, orabout 1.6%, or about 1.55 or about 1.4% or about 1.3% or about 1.2% orabout 1.1%, or about 0.9% or about 0.8%, or about 0.7%, or about 0.6% orabout 0.5% by weight of the composition or less than any of theaforesaid amounts.

Preferably, the fatty alcohol and/or fatty acid and/or wax are solid atambient temperature. In certain embodiments, the fatty alcohol and/orthe fatty acid and/or the wax or the mixture of them have a meltingpoint of more than about 40° C.

Propellant

In one or more embodiments, the composition is a foamable composition,and further comprises a propellant. Any compatible propellant can beused. In one or more embodiments, the propellant is a gas at roomtemperature under normal pressure and which can be liquefied atincreased pressure at room temperature. Examples of propellants include,without limitation, hydrocarbon propellants such as butane, propane,isobutane, dimethyl ether, fluorocarbons such as 1,1,1,2tetrafluoroethane (Dymel 134a), and 1,1,1,2,3,3,3 heptafluoropropane(Dymel 227), and mixtures thereof. In one or more embodiments, ahydrocarbon mixture AP-70 (a mixture of about 30% w/w butane, 20% w/wisobutane and 50% w/w propane) is used.

In one or more embodiments, the composition comprises about 0.1% w/w toabout 0.3% w/w of fumed (modified) silica. In one or more embodiments,the composition comprises about 1% w/w to about 4% w/w of minocyclinehydrochloride or a doxycycline or a tetracycline antibiotic. In one ormore embodiments, the composition comprises about 3% w/w to about 15%w/w of propellant based on the weight of the total composition. In oneor more embodiments, the composition comprises about 3% w/w to about 25%w/w of propellant based on the weight of the total composition. In oneor more embodiments, the composition comprises about 3% w/w to about 35%w/w of propellant based on the weight of the total composition. In oneor more embodiments, the composition comprises about 5% w/w to about 30%w/w of propellant based on the weight of the total composition.

Other Ingredients

In certain embodiments, the composition is free of one or more of apetrolatum, surface active agents, protic solvents, certain polaraprotic solvents, isopropyl myristate, polyethylene gelling agents,polyethylene homopolymers, polyethylene copolymers, selenium derivativesand silicone thickening agents; and in certain embodiments, the foamablecomposition is substantially free of such excipients. In the contextherein, the term “substantially-free” relates to a composition thatcontains a total of less than about 0.4% of a petrolatum, surface activeagents, protic solvents, certain polar aprotic solvents, isopropylmyristate, polyethylene gelling agents, polyethylene homopolymers,polyethylene copolymers, selenium derivatives and silicone thickeningagents cumulatively. Preferably, the composition comprises less thanabout 0.2% of two or more or all thereof by weight of petrolatum,surface active agents, protic solvents, certain polar aprotic solvents,isopropyl myristate, polyethylene gelling agents, polyethylenehomopolymers, polyethylene copolymers, selenium derivatives and siliconethickening agents cumulatively or, and more preferably less than about0.1% individually or of two or more or all thereof cumulatively.

In one or more embodiments, the composition is substantiallyalcohol-free, i.e., free of short chain alcohols having up to 5 carbonatoms in their carbon chain skeleton. In other embodiments, thecomposition comprises less than about 5% by weight final concentrationof short chain alcohols, for example, less than 2% by weight, or lessthan 1% by weight. In certain embodiments, the composition is free orsubstantially free of ethanol, propanol, butanol and pentanol.

Surface Active Agents

For clarification, in the context herein whilst the term “standardsurfactant” or “customary surfactant” refers herein to customarynon-ionic, ionic, anionic, cationic, zwitterionic, amphoteric andamphiphilic surfactants. A fatty alcohol or a fatty acid and certainwaxes are not regarded as a standard surfactant. However, in contrast,ethers or esters formed from such fatty alcohols or fatty acids can beregarded as a customary surfactant.

Surfactants of all kinds are undesirable in accordance with the presentcompositions and methods as (i) they were found to cause degradation ofthe tetracycline antibiotic; and (ii) they are generally known topossess irritation potential.

Non-limiting examples of classes of non-ionic surfactants that areundesirable according to the present invention include: (i)polyoxyethylene sorbitan esters (polysorbates), such as polysorbate 20,polysorbate 40, polysorbate 60 and polysorbate 80; (ii) sorbitan esters,such as sorbitan monolaurate and sorbitan monooleate; (iii)polyoxyethylene fatty acid esters, such as, PEG-8 stearate, PEG-20stearate, PEG-40 stearate, PEG-100 stearate, PEG-150 distearate, PEG-8laurate, PEG-10 laurate, PEG-12 laurate, PEG-20 laurate, PEG-8 oleate,PEG-9 oleate, PEG-10 oleate, PEG-12 oleate, PEG-15 oleate and PEG-20oleate; (iv) PEG-fatty acid diesters; (v) polyethylene glycol (PEG)ethers of fatty alcohols; (vi) glycerol esters, such as glycerylmonostearate, glyceryl monolaurate, glyceryl monopalmitate and glycerylmonooleate; (vii) PEG-fatty acid mono- and di-ester mixtures; (viii)polyethylene glycol glycerol fatty acid esters; (ix) propylene glycolfatty acid esters; (x) mono- and diglycerides; (xi) sugar esters (mono-,di- and tri-esters of sucrose with fatty acids) and (xii) PEG alkylphenols.

As disclosed herein, in the context of the compositions and methodsprovided herein, while fatty alcohols, fatty acids, and certain waxesare somewhat amphiphilic, these substances are not effective asstand-alone surfactants that can stabilize an emulsion, let alonefoamable emulsion compositions, because of their very weak emulsifyingcapacity and further due to their weak foaming capacity on their own.

They are occasionally used in a supporting role as co-emulsifiers, i.e.,in combination with a standard surfactant but are commonly used asthickeners and have successfully been used as foam adjuvants to assistcustomary surfactants to boost foam quality and stability. For thepurposes of forming an emulsion they are usually regarded as an oil andthus have a “required” HLB value for the purpose of determining whatstandard surfactant might be appropriate to use with the oil phase.

Generally, surfactants are known to possess irritation potential. Oneway to try and reduce or minimize potential irritation and drying of theskin or mucosa due to surfactants and their repeated use, especiallywhen formulations are to be left on the skin or mucosa rather than beingwashed off, is to use essentially or primarily nonionic surfactants atsignificant concentrations, although preferably below 5%. Theidentification of formulations which produce gels and quality breakablefoam yet omit customary surfactants from a composition can contribute toimproved tolerability of such a composition and can be an importantadvantage. This is especially so when a formulation is to be applied toa very sensitive target site, and particularly so on a repeated basis.

In certain embodiments, the composition is free of customarysurfactants, also known as “surfactant-free,” and in certainembodiments, the foamable composition is substantially free of customarysurfactants, also known as “substantially surfactant-free”.

In certain embodiments, the composition is free or substantially free ofan ionic surfactant. In certain embodiments, the composition is free orsubstantially free of a zwitterionic surfactant. In certain embodiments,the composition is free or substantially free of a non-ionic surfactant.

Protic Solvents

Protic solvents, such as short chain alcohols, glycols and glycerin areincompatible with tetracyclines and therefore are undesirable. Incertain embodiments, the composition is free or substantially free ofprotic solvents.

Aprotic Polar Solvents

It was discovered in PCT Publication No. WO11/039637 that certain polaraprotic solvents are incompatible with tetracycline antibiotics. Thus,aprotic polar solvents, such as dimethyl sulfoxide (DMSO),dimethylformamide (DMF), acetonitrile, acetone, methyl ethyl ketone,1,4-Dioxane and tetrahydrofuran (THF), N-methylpyrrolidone, pyridine,piperidine, dimethylformamide, N-methyl-2-pyrrolidone and1-methyl-2-pyrrolidinone) and azone (1-dodecylazacycloheptan-2-one) areundesirable. In certain embodiments, the composition is free orsubstantially free of aprotic polar solvents.

Silicone Thickening Agents

Silicone thickening agents comprise one or more polysiloxane-derivedcomponents. Such polysiloxanes are typically cross-linked and they haverubber-like characteristics, which require their solubilization in anoil, usually a silicone oil. An example of such a silicone thickeningagent is ST-Elastomer 10 (Dow Corning), which is a mixture of highmolecular weight dimethicone crosspolymer (12%), in cyclopentasiloxane(cyclomethicone, silicone solvent). With reference to bioavailability ofan active agent in the skin following topical application, it isconceivable that cross co-polymers will create a non-permeable filmwhich should block skin penetration and therefore, it is undesirable.Further, in the context of a breakable foam, cyclomethicone is known asa defoamer and therefore its presence in high concentrations in thebreakable hydrophobic composition is undesirable. In certainembodiments, the composition is free or substantially free of siliconethickening agents other than cyclomethicone.

In one or more other specific embodiments, the drug carrier isformulated substantially free of elastomers. In one or more otherspecific embodiments, the drug carrier is formulated essentially free ofelastomers. In one or more other specific embodiments, the drug carrieris formulated substantially free of silicones. In one or more otherspecific embodiments, the drug carrier is formulated essentially free ofsilicones. In one or more other specific embodiments, the drug carrieris formulated with less than about 30% silicones, or less than about 25%silicones, or less than about 20% silicones, or less than about 15%silicones, or less than about 10% silicones, or less than about 7.5%silicones, or less than about 5% silicones or less than about 2%silicones; or less than about 1% silicones; or less than about 0.5%silicones; or about 1% to about 5% silicones; or about 0.5% to about 3%silicones. In one or more other specific embodiments, the drug carrierdoes not comprise a silicone other than cyclomethicone. In one or moreother embodiments, the drug carrier does not comprise one or morevolatile silicones. In other embodiments, volatile silicones are presentat about 3% or less.

In one or more embodiments, semi-solid hydrophobic oils are a subsidiarycomponent in the composition, for example being present at less thanabout 45%, at less than about 40%, at less than about 35%, at less thanabout 30%, at less than about 25%, less than about 20%, less than about15%, less than about 10%, or less than about 5% by weight of thecomposition. In one or more alternative embodiments, semi-solid oils areomitted.

Polyols

The identification of a “polyol,” as used herein, is an organicsubstance that contains at least two hydroxyl groups in its molecularstructure. In one or more embodiments, the polyol is a diol (a compoundthat contains two hydroxyl groups in its molecular structure). Examplesof diols include propylene glycol (e.g., 1,2-propylene glycol and1,3-propylene glycol), butanediol (e.g., 1,2-butanediol, 1,3-butanediol,2,3-butanediol and 1,4-butanediol), butanediol (e.g., 1,3-butanediol and1,4-butenediol), butynediol, pentanediol (e.g., pentane-1,2-diol,pentane-1,3-diol, pentane-1,4-diol, pentane-1,5-diol, pentane-2,3-dioland pentane-2,4-diol), hexanediol (e.g., hexane-1,6-diol hexane-2,3-dioland hexane-2,56-diol), octanediol (e.g., 1,8-octanediol), neopentylglycol, 2-methyl-1,3-propanediol, diethylene glycol, triethylene glycol,tetraethylene glycol, dipropylene glycol and dibutylene glycol.

In one or more embodiments, the polyol is a triol (a compound thatcontains three hydroxyl groups in its molecular structure), such asglycerin, butane-1,2,3-triol, butane-1,2,4-triol and hexane-1,2,6-triol.

In one or more embodiments, the polyol is a saccharide. Exemplarysaccharides include, but are not limited to, monosaccharides,disaccharides, oligosaccharides, and sugar alcohols.

A monosaccharide is a simple sugar that cannot be hydrolyzed to smallerunits. The empirical formula is (CH₂O)_(n) and can range in size fromtrioses (n=3) to heptoses (n=7). Exemplary monosaccharide compounds areribose, glucose, fructose, and galactose.

Disaccharides are made up of two monosaccharides joined together, suchas sucrose, maltose, and/or lactose.

In one or more embodiments, the polyol is a sugar alcohol (also known asa polyol, polyhydric alcohol, or polyalcohol) or a hydrogenated form ofsaccharide, whose carbonyl group (aldehyde or ketone, reducing sugar)has been reduced to a primary or secondary hydroxyl group. They arecommonly used for replacing sucrose in foodstuffs, often in combinationwith high intensity artificial sweeteners to counter the low sweetness.Some exemplary sugar alcohols, which are suitable for use according tothe present disclosure are mannitol, sorbitol, xylitol, maltitol,lactitol. (Maltitol and lactitol are not completely hydrogenatedcompounds—they are a monosaccharide combined with a polyhydric alcohol.)Mixtures of polyols, including (1) at least one polyol comprises orselected from a diol and a triol; and (2) a saccharide are contemplatedwithin the scope of the present disclosure.

According to some embodiments, the composition is polyol free, i.e.,free of polyols.

In other embodiments, the composition is substantially free andcomprises less than about 5% final concentration of polyols, preferablyless than 2%, more preferably less than 1%; or about 1% to about 5%polyols; or about 0.5% to about 3% polyols. In some embodiments thecomposition comprises de minimis amounts of polyols. Where a formulationincludes insignificant or de minimis amounts of polyols, such as lessthan 0.05%, the formulation is considered to be essentially free ofthem.

In an embodiment, the polyol is linked to a hydrophobic moiety. In thecontext of the present disclosure, a polyol linked to a hydrophobicmoiety is still defined as a “polyol” as long as it still contains twoor more free hydroxyl groups.

In an embodiment, the polyol is linked to a hydrophilic moiety. In thecontext of the present disclosure, a polyol linked to a hydrophilicmoiety is still defined “polyol” as long as it still contains two ormore free hydroxyl groups.

In one or more embodiments, the hydrophobic composition further containsan anti-infective agent, comprises or selected from the group of anantibiotic agent, an antibacterial agent, an antifungal agent, an agentthat controls yeast, an antiviral agent, and an antiparasitic agent. Inan embodiment, the anti-infective agent comprises a tricyclicantibiotic. Not only can combining the anti-infective effect of ahydrophobic composition, with an anti-infective agent result in asynergistic effect and consequently higher success rate of the treatmentbut the combination with the viscosity modifying agent achieves aformulation in which the active pharmaceutical ingredient is chemicallystable and the formulation is physically stable as demonstrated hereinin the Examples. Moreover, the use of hydrophobic based water-freeformulation can maximize the antimicrobial and antiviral potentials ofthe formulations. Delivery topically can be improved by using ahydrophobic carrier with a hydrophobic API. Storage in sealed, light andairtight canisters can assist in preserving the formulations.

In one or more embodiments, the hydrophobic composition is substantiallyfree of at least one or more of surface active agents, protic solvents,polar aprotic solvents, and silicone thickening agents.

In one or more embodiments, the hydrophobic composition is substantiallyfree of at least one or more of surface active agents, polymeric gellingagents, polyols, short chain alcohols, and silicone thickening agents.

In one or more embodiments, the hydrophobic composition contains lessthan about 0.4% by weight of the composition; or less than about 0.2% byweight of the composition; or less than about 0.1% by weight of thecomposition of one of or a combination of two, three or all of surfaceactive agents, protic solvents, polar aprotic solvents, and siliconethickening agents.

In one or more embodiments, any composition of the present disclosurecan also contain a fragrance. In one or more embodiments, the fragranceis at a concentration of about 0.1% by weight to about 1% by weight.

In one or more embodiments, the composition comprises about 35% w/w toabout 65% w/w of soybean oil. In one or more embodiments, thecomposition comprises about 16.5% w/w to about 30.7% w/w of coconut oil.In one or more embodiments, the composition comprises about 3.5% w/w toabout 6.5% w/w of cyclomethicone. In one or more embodiments, thecomposition comprises about 2% w/w to about 3.7% w/w of light mineraloil.

In one or more embodiments, the composition comprises about 2.5% w/w toabout 4.6% w/w of cetostearyl alcohol. In one or more embodiments, thecomposition comprises about 2% w/w to about 4% w/w of stearic acid. Inone or more embodiments, the composition comprises about 1.8% w/w toabout 3.3% w/w of myristyl alcohol. In one or more embodiments, thecomposition comprises about 1% w/w to about 2% w/w of stearyl alcohol.In one or more embodiments, the composition comprises about 0.5% w/w toabout 1.5% w/w of behenyl alcohol. In one or more embodiments, thecomposition comprises about 1% w/w to about 3% w/w of hydrogenatedcastor oil. In one or more embodiments, the composition comprises about1% w/w to about 3% w/w of beeswax.

In one or more embodiments, the composition comprises about 48% w/w toabout 51% w/w of soybean oil. In one or more embodiments, thecomposition comprises about 23% w/w to about 24% w/w of coconut oil. Inone or more embodiments, the composition comprises about 4% w/w to about6% w/w of cyclomethicone. In one or more embodiments, the compositioncomprises about 1% w/w to about 5% w/w of light mineral oil.

In one or more embodiments, the composition comprises about 3% w/w toabout 4% w/w of cetostearyl alcohol. In one or more embodiments, thecomposition comprises about 2% w/w to about 4% w/w of stearic acid. Inone or more embodiments, the composition comprises about 2% w/w to about3% w/w of myristyl alcohol. In one or more embodiments, the compositioncomprises about 1% w/w to about 2% w/w of stearyl alcohol. In one ormore embodiments, the composition comprises about 0.5% w/w to about 1.5%w/w of behenyl alcohol. In one or more embodiments, the compositioncomprises about 1% w/w to about 3% w/w of hydrogenated castor oil. Inone or more embodiments, the composition comprises about 1% w/w to about3% w/w of beeswax.

In one or more embodiments, the composition comprises about 0.1% w/w toabout 0.3% w/w of fumed (modified) silica. In one or more embodiments,the composition comprises about 1% w/w to about 4% w/w of minocyclinehydrochloride or a doxycycline or a tetracycline antibiotic. In one ormore embodiments, the composition comprises about 3% w/w to about 15%w/w of propellant based on the weight of the total composition.

In one or more embodiments the tetracycline composition furthercomprises an additional active agent selected from the group consistingof an anti parasitic agent, an azole, an anti-histamine, α1 and α2adrenergic receptor agonist, a vasoconstrictor and mixtures of any twoor more thereof.

In one or more embodiments the tetracycline composition furthercomprises an additional active agent selected from the group consistingof ivermectine, metronidazole, azelastine, oxymetazoline, brimonidineand mixtures of any two or more thereof.

In one or more embodiments the tetracycline composition furthercomprises at least one of an additional active selected from an antiparasitic agent, an azole, an anti-histamine, α1 and α2 adrenergicreceptor agonist or a vasoconstrictor.

In one or more embodiments the tetracycline composition furthercomprises at least one of an additional active selected fromivermectine, metronidazole, azelastine, oxymetazoline or brimonidine.

In one or more embodiments the tetracycline composition furthercomprises at least one of an additional active selected from an antiparasitic agent, an azole, an anti-histamine, α1 and α2 adrenergicreceptor agonist or a vasoconstrictor, wherein the composition isconfigured for the treatment of rosacea.

In one or more embodiments the tetracycline composition furthercomprises at least one of an additional active selected fromivermectine, metronidazole, azelastine, oxymetazoline or brimonidine,wherein the composition is configured for the treatment of rosacea.

In one or more embodiments the composition comprises an active agentselected from the group consisting of an anti parasitic agent, an azole,an anti-histamine, α1 and α2 adrenergic receptor agonist, avasoconstrictor and mixtures of any two or more thereof.

In one or more embodiments the composition comprises an active agentselected from the group consisting of ivermectine, metronidazole,azelastine, oxymetazoline, brimonidine and mixtures of any two or morethereof.

In one or more embodiments the composition comprises at least one activeagent selected from an anti parasitic agent, an azole, ananti-histamine, α1 and α2 adrenergic receptor agonist and avasoconstrictor.

In one or more embodiments the composition comprises at least one activeagent selected from the group consisting of ivermectine, metronidazole,azelastine, oxymetazoline, brimonidine and mixtures of any two or morethereof.

In one or more embodiments the composition comprises at least one activeagent selected from an anti parasitic agent, an azole, ananti-histamine, α1 and α2 adrenergic receptor agonist and avasoconstrictor, wherein the composition is configured for the treatmentof rosacea.

In one or more embodiments the composition comprises at least one activeagent selected from ivermectine, metronidazole, azelastine,oxymetazoline and brimonidine, wherein the composition is configured forthe treatment of rosacea.

In one or more embodiments the composition is configured to treat adisorder selected from an inflammatory disorders, non inflammatorydisorders, atopic dermatitis, acne, dermatitis, impetigo, psoriasis androsacea.

In one or more embodiments the composition is configured to treat atleast one disorder selected from an inflammatory disorder, noninflammatory disorder, atopic dermatitis, acne, dermatitis, impetigo,psoriasis and rosacea.

In one or more embodiments a method for treatment of rosacea, whereinthe tetracycline composition comprises an additional agent, wherein theadditional agent is selected from tetracycline antibiotic, ivermectin,azelaic acid, azelastine, isotretinoin, metronidazole, brimonidine,oxymetazoline, xylometazolin, sodium sulfacetamide and sulfur,tretinoin, a retinoid, an anti parasitic agent, an azole, ananti-histamine, α1 and α2 adrenergic receptor agonist and avasoconstrictor.

In another aspect, the ingredients of the carrier can be selected fortheir compatibility with tetracycline antibiotics as described. In oneor more embodiments it was not sufficient to identify single ingredientsthat were compatible with tetracycline antibiotics but formulations hadto be found in which the ingredients in combination were also compatiblewith tetracycline antibiotics.

In one or embodiments, topical tetracycline treatments can be given withor followed by application of a steroid or a hyaluronic acid or acollagen or a silicone, clindamycin, or metronidazole, or erythromycin,or ivermectin, or azelaic acid, or brimonidine, or sodium sulfacetamideand sulfur, or tretinoin, or a retinoid or mixtures of any two or morethereof, for example to ameliorate or reduce scarring or skin damageeffects. In an embodiment treatment with topical tetracycline of dryeyes caused by ocular rosacea could be followed with liquid tears andcleaning of eyelids every day with warm water.

Therapeutic topical compositions must stay on the skin for a sufficientperiod of time to allow the active agent to be absorbed onto the skin,to perform its activity and to further exert a preventative effect. Theyshould preferably not irritate the skin; and they should be perceived bythe patient as pharmaceutically convenient in order to achievesufficient patient compliance. By “pharmaceutically convenient”, it ismeant that the skin look and feel to the patient is good, i.e., it mustnot be too watery or too greasy and it must easily be applied.

A disadvantage of known compositions having an ointment base isgreasiness; these compositions are generally considered less usable inthe case of facial treatment of rosacea. Another disadvantage is thatmany known compositions contain surfactants, which can be irritants. Itis therefore an advantage of the compositions provided herein that theyare breakable gels or foams; and therefore are easy to apply to the skinand also avoid skin irritation that has been associated withcompositions containing surfactants

Breakable gels, which comprise liquid oils and a thickening agent, arealso very convenient for use, as they liquefy on application of mildshear force such as gentle rubbing, and in turn, they readily absorbonto the skin.

Foam is advantageous in the topical treatment of skin diseases,especially in skin afflicted with rosacea, since it is light and easy toapply and collapses and spreads with a minor mechanical force like asimple rub. When dispensed, even in small quantities, drug delivery inthe form of foam can also cover a larger surface area of applicationwhile also facilitating better product application in areas whereconventional topical products cannot be as effective. Foam absorbsrapidly—without the need of repeated rubbing—which is helpful andimportant for treatment of damaged or irritated skin, sores, andlesions. As the composition is absorbed quickly, this can contribute toa positive treatment effect by the vehicle alone, or when in combinationwith the active agent, a higher percentage effect by the active agentmay be observed.

Thermally stable foam which breaks upon application of mild shear forceis extremely advantageous in the topical treatment of skin diseases. Itcan be applied directly onto skin or hands of the patient withoutcollapsing. The hydrophobic compositions according to the descriptionprovided herein facilitate easy application and even distribution of theactive agent, thereby improving treatment convenience. This is incontrast to a temperature sensitive foam that collapses immediately onthe skin so that it must first be applied onto a cool surface and thenquickly applied using fingertips onto the surface, which can impedepatient compliance

The formulation packaged into an aerosol container is devoid of anycontact with air, light, or any other form of contamination (e.g.,moisture) as it is a completely sealed system throughout the life of theproduct. Thus, light and oxidation sensitive active agents can beeffectively stabilized in the aerosol system.

It should be noted that hydrophobic compositions disclosed herein can beapplied to the target site as a gel or a semi-solid gel or foam. Incertain other embodiments, it can be applied as a liquid gel or as acollapsed foam. In one or more embodiments, the composition isthixotropic. In one or more embodiments, the gel formulation subjectedto constant shear rate shows a reduction in viscosity with time. In oneor more further embodiments, after the material is allowed to rest for aperiod of time, the viscosity increases again. In one or moreembodiments, there is provided prior to adding propellant a solid orsemi-solid composition or gel. In one or more embodiments, thecomposition or gel is a liquid. In one or more embodiments thepropellant is miscible with and dilutes the composition.

Upon packaging of the foamable composition in an aerosol container andadding a propellant, a shakable and homogenous foamable compositionresults, which upon dispensing, forms a breakable foam with good toexcellent quality. The resulting foam is pharmaceutically equivalent tothe respective gel (prior to adding the propellant), since immediatelyupon dispensing of the foam the propellant evaporates and thecomposition, upon collapse, is similar or identical to that of the gel.This is an important pragmatic advantage because many drug developmentactivities, including expensive and lengthy toxicology studies withnumerous animals and clinical trials with thousands of patients can besaved by conducting such studies once for either the gel or foampresentation instead of twice (for each presentation).

In one or more embodiments, such a composition is presented as abreakable gel, which breaks down with mild mechanical force.

In one or more embodiments, the hydrophobic composition when packaged inan aerosol container to which is added a liquefied or compressed gaspropellant the composition provides upon release from the container abreakable foam of at least good quality that breaks easily uponapplication of mechanical force.

In one or more embodiments, the composition is a foamable compositionthat is thermally stable at skin temperature.

In one or more embodiments, when the above composition is filled into anaerosol can or canister and pressurized with a propellant a foamablecomposition is produced.

In one or more embodiments, a hydrophobic foamable composition (e.g.,foam or gel) provided herein comprises: a) about 60% to about 99% byweight of at least one hydrophobic solvent; b) about 1% to about 22% byweight of at least one viscosity modifying agent; and c) about 0.1% toabout 18% of a tetracycline antibiotic (e.g., minocycline HCl ordoxycycline hyclate).

In one or more embodiments, a hydrophobic foamable composition (e.g.,foam or gel) provided herein comprises: a) about 60% to about 99% byweight of at least one hydrophobic solvent or carrier; b) about 1% toabout 22% by weight of at least one viscosity modifying agent; c) about0.1% to about 18% by weight of a tetracycline antibiotic (e.g.,minocycline HCl or doxycycline hyclate); and d) an additional activeagent.

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 70% to about 90% by weight of atleast one hydrophobic solvent; b) about 10 to about 22% by weight of atleast one viscosity modifying agent; and c) about 0.5% to about 8% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline hyclate).

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 70% to about 90% by weight of atleast one hydrophobic solvent or carrier; b) about 10 to about 22% byweight of at least one viscosity modifying agent; c) about 0.5% to about8% by weight of a tetracycline antibiotic (e.g., minocycline HCl ordoxycycline hyclate); and d) an additional active agent.

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 75% to about 90% by weight of atleast one hydrophobic solvent; b) about 10 to about 22% by weight of atleast one viscosity modifying agent; and c) about 0.5% to about 2% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline hyclate).

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 75% to about 90% by weight of atleast one hydrophobic solvent or carrier; b) about 10 to about 22% byweight of at least one viscosity modifying agent; c) about 0.5% to about2% by weight of a tetracycline antibiotic (e.g., minocycline HCl ordoxycycline hyclate); and d) an additional active agent.

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 72% to about 88% by weight of atleast one hydrophobic solvent; b) about 10 to about 22% by weight of atleast one viscosity modifying agent; and c) about 2% to about 6% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline hyclate).

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 72% to about 98% by weight of atleast one hydrophobic solvent; b) about 1% to about 18% by weight of atleast one viscosity modifying agent; and c) about 1% to about 10% of atetracycline antibiotic (e.g., minocycline HCl or doxycycline hyclate).

In one or more embodiments, a hydrophobic foamable composition or gelprovided herein comprises: a) about 72% to about 88% by weight of atleast one hydrophobic solvent or carrier; b) about 10 to about 22% byweight of at least one viscosity modifying agent; c) about 2% to about6% by weight of a tetracycline antibiotic (e.g., minocycline HCl ordoxycycline hyclate); and d) an additional active agent.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the method comprises: a) about 60% to about 95% by weight of atleast one hydrophobic solvent or carrier; b) at least oneviscosity-modifying agent selected from the group consisting of a fattyalcohol, a fatty acid, and a wax; c) a therapeutically effective amountof a tetracycline antibiotic; and d) an additional active agent.

In one or more embodiments, there is provided a hydrophobic foam or gelcomposition comprising: a) about 50% by weight of soybean oil; b) about23.6% by weight of coconut oil; c) about 5% by weight of cyclomethicone;d) about 2.8% by weight of light mineral oil; e) about 3.5% by weight ofcetostearyl alcohol; f) about 3% by weight of stearic acid; g) about2.5% by weight of myristyl alcohol; about 2% by weight of hydrogenatedcastor oil; h) about 2% by weight of beeswax; i) about 1.5% by weight ofstearyl alcohol; j) about 1.1% by weight of behenyl alcohol; and k)about 3% by weight of minocycline.

In one or more embodiments, there is provided a hydrophobic foam or gelcomposition comprising: a) about 50% by weight of soybean oil; b) about23.6% by weight of coconut oil; c) about 5% by weight of cyclomethicone;d) about 4.3% by weight of light mineral oil; e) about 3.5% by weight ofcetostearyl alcohol; f) about 3% by weight of stearic acid; g) about2.5% by weight of myristyl alcohol; h) about 2% by weight ofhydrogenated castor oil; i) about 2% by weight of beeswax; j) about 1.5%by weight of stearyl alcohol; k) about 1.1% by weight of behenylalcohol; and l) about 1.5% by weight of minocycline.

In one or more embodiments, there is provided a hydrophobic foam or gelcomposition comprising: a) about 35% to about 65% by weight of soybeanoil; b) about 16.5% to about 30.7% by weight of coconut oil; c) about3.5% to about 6.5% by weight of cyclomethicone; d) about 2% to about3.7% by weight of light mineral oil; e) about 2.5% to about 4.6% byweight of cetostearyl alcohol; f) about 2.1% to about 4% by weight ofstearic acid; g) about 1.8% to about 3.3% by weight of myristyl alcohol;h) about 1.4% to about 2.6% by weight of hydrogenated castor oil; i)about 1.4% to about 2.6% by weight of beeswax; j) about 1% to about 2%by weight of stearyl alcohol; k) about 0.8% to about 1.4% by weight ofbehenyl alcohol; and l) about 2.1% to about 4% by weight of minocycline.

In one or more embodiments, there is provided a hydrophobic foam or gelcomposition comprising: a) about 35% to about 65% by weight of soybeanoil; b) about 16.5% to about 30.7% by weight of coconut oil; c) about3.5% to about 6.5% by weight of cyclomethicone; d) about 3% to about5.6% by weight of light mineral oil; e) about 2.5% to about 4.6% byweight of cetostearyl alcohol; f) about 2.1% to about 4% by weight ofstearic acid; g) about 1.8% to about 3.3% by weight of myristyl alcohol;h) about 1.4% to about 2.6% by weight of hydrogenated castor oil; i)about 1.4% to about 2.6% by weight of beeswax; j) about 1% to about 2%by weight of stearyl alcohol; k) about 0.8% to about 1.4% by weight ofbehenyl alcohol; and l) about 1% to about 2% by weight of minocycline.

In one or more embodiments there is provided a method of treatment forreducing skin redness in a subject having a disorder in which one of theetiological factors is skin redness comprising applying a topicalcomposition to an area of skin with the disorder, wherein the topicalcomposition comprises: a) about 50% by weight of soybean oil; b) about23.6% by weight of coconut oil; c) about 5% by weight of cyclomethicone;d) about 2.8% by weight of light mineral oil; e) about 3.5% by weight ofcetostearyl alcohol; f) about 3% by weight of stearic acid; g) about2.5% by weight of myristyl alcohol; h) about 2% by weight ofhydrogenated castor oil; i) about 2% by weight of beeswax; j) about 1.5%by weight of stearyl alcohol; k) about 1.1% by weight of behenylalcohol; and l) about 3% by weight of minocycline.

In one or more embodiments there is provided a method of treatment forreducing skin redness in a subject having a disorder in which one of theetiological factors is skin redness comprising applying a topicalcomposition to an area of skin with the disorder, wherein the topicalcomposition comprises: a) about 50% by weight of soybean oil; b) about23.6% by weight of coconut oil; c) about 5% by weight of cyclomethicone;d) about 4.3% by weight of light mineral oil; e) about 3.5% by weight ofcetostearyl alcohol; f) about 3% by weight of stearic acid; g) about2.5% by weight of myristyl alcohol; h) about 2% by weight ofhydrogenated castor oil; i) about 2% by weight of beeswax; j) about 1.5%by weight of stearyl alcohol; k) about 1.1% by weight of behenylalcohol; and l) about 1.5% by weight of minocycline.

In one or more embodiments there is provided a method of treatment forreducing skin redness in a subject having a disorder in which one of theetiological factors is skin redness comprising applying a topicalcomposition to an area of skin with the disorder, wherein the topicalcomposition comprises: a) about 35% to about 65% by weight of soybeanoil; b) about 16.5% to about 30.7% by weight of coconut oil; c) about3.5% to about 6.5% by weight of cyclomethicone; d) about 2% to about3.7% by weight of light mineral oil; e) about 2.5% to about 4.6% byweight of cetostearyl alcohol; f) about 2.1% to about 4% by weight ofstearic acid; g) about 1.8% to about 3.3% by weight of myristyl alcohol;about 1.4% to about 2.6% by weight of hydrogenated castor oil; i) about1.4% to about 2.6% by weight of beeswax; j) about 1% to about 2% byweight of stearyl alcohol; k) about 0.8% to about 1.4% by weight ofbehenyl alcohol; and l) about 2.1% to about 4% by weight of minocycline.

In one or more embodiments there is provided a method of treatment forreducing skin redness in a subject having a disorder in which one of theetiological factors is skin redness comprising applying a topicalcomposition to an area of skin with the disorder, wherein the topicalcomposition comprises: a) about 35% to about 65% by weight of soybeanoil; b) about 16.5% to about 30.7% by weight of coconut oil; c) about3.5% to about 6.5% by weight of cyclomethicone; d) about 3% to about5.6% by weight of light mineral oil; e) about 2.5% to about 4.6% byweight of cetostearyl alcohol; f) about 2.1% to about 4% by weight ofstearic acid; g) about 1.8% to about 3.3% by weight of myristyl alcohol;h) about 1.4% to about 2.6% by weight of hydrogenated castor oil; i)about 1.4% to about 2.6% by weight of beeswax; j) about 1% to about 2%by weight of stearyl alcohol; k) about 0.8% to about 1.4% by weight ofbehenyl alcohol; and l) about 1% to about 2% by weight of minocycline.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 57.6% to about87.5% by weight of heavy mineral oil; b) about 3.5% to about 6.5% byweight of light mineral oil; c) about 3.2% to about 5.9% by weight ofstearyl alcohol; d) about 1.75% to about 3.25% by weight of stearicacid; e) about 0.8% to about 1.4% by weight of behenyl alcohol; and f)about 3.3% to about 6.1% by weight of minocycline hydrochloride ordoxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 65.8% to about86% by weight of heavy mineral oil; b) about 4% to about 6% by weight oflight mineral oil; c) about 3.6% to about 5.4% by weight of stearylalcohol; d) about 2% to about 3% by weight of stearic acid; e) about0.9% to about 1.3% by weight of behenyl alcohol; and f) about 3.7% toabout 5.6% by weight of minocycline hydrochloride or doxycyclinehyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 74% to about 84%by weight of heavy mineral oil; b) about 4.5% to about 5.5% by weight oflight mineral oil; c) about 4.1% to about 5% by weight of stearylalcohol; d) about 2.3% to about 2.8% by weight of stearic acid; e) about1% to about 1.2% by weight of behenyl alcohol; and f) about 4.2% toabout 5.1% by weight of minocycline hydrochloride or doxycyclinehyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 31.8% to about59.2% by weight of light mineral oil; b) about 31.5% to about 58.5% byweight of soybean oil; c) about 2.8% to about 5.2% by weight of stearylalcohol; d) about 0.2% to about 0.8% by weight of behenyl alcohol; ande) about 3.3% to about 6.2% by weight of minocycline hydrochloride ordoxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 82.24% by weightof heavy mineral oil; b) about 5% by weight of light mineral oil; c)about 4.5% by weight of stearyl alcohol; d) about 2.5% by weight ofstearic acid; e) about 1.1% by weight of behenyl alcohol; and f) about4.66% by weight of minocycline hydrochloride or doxycycline hyclate. Inone or more embodiments, the hydrophobic gel or foam composition for usein the methods provided herein comprises: a) about 62% to about 91.7% byweight of heavy mineral oil, light mineral oil or combinations thereof;b) about 2.6% to about 4.8% by weight of stearyl alcohol; c) about 1.75%to about 3.25% by weight of stearic acid; d) about 0.5% to about 0.9% byweight of behenyl alcohol; e) about 0.14% to about 0.26% by weight ofparaffin 51-53; and f) about 3.3% to about 6.1% by weight of minocyclinehydrochloride or doxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 70.6% to about90.6% by weight of heavy mineral oil, light mineral oil or combinationsthereof; b) about 3% to about 4.4% by weight of stearyl alcohol; c)about 2% to about 3% by weight of stearic acid; d) about 0.56% to about0.84% by weight of behenyl alcohol; e) about 0.16% to about 0.24% byweight of paraffin 51-53; and f) about 3.7% to about 5.6% by weight ofminocycline hydrochloride or doxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 79.4% to about89.4% by weight of heavy mineral oil, light mineral oil or combinationsthereof; b) about 3.3% to about 4.1% by weight of stearyl alcohol; c)about 2.3% to about 2.8% by weight of stearic acid; d) about 0.63% toabout 0.77% by weight of behenyl alcohol; e) about 0.18% to about 0.22%by weight of paraffin 51-53; and f) about 4.2% to about 5.6% by weightof minocycline hydrochloride or doxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 63% to about 98%by weight of heavy mineral oil; b) about 0.1% to about 15% by weight oflight mineral oil; c) about 0.5% to about 7% by weight of stearylalcohol; d) about 0.5% to about 5% by weight of stearic acid; e) about0.2% to about 2% by weight of behenyl alcohol; and f) about 1% to about8% by weight of minocycline hydrochloride or doxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 73% to about 98%by weight of heavy mineral oil, light mineral oil or combinationsthereof; b) about 0.5% to about 7% by weight of stearyl alcohol; c)about 0.5% to about 5% by weight of stearic acid; d) about 0.2% to about2% by weight of behenyl alcohol; e) about 0.1% to about 5% by weight ofparaffin 51-53; and f) about 1% to about 8% by weight of minocyclinehydrochloride or doxycycline hyclate.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 81.94% by weightof heavy mineral oil; b) about 5% by weight of light mineral oil; c)about 4.5% by weight of stearyl alcohol; d) about 2.5% by weight ofstearic acid; e) about 1.1% by weight of behenyl alcohol; f) about 4.66%by weight of minocycline hydrochloride or doxycycline hyclate; and g)about 0.3% by weight of adapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 82% by weight ofheavy mineral oil; b) about 5% by weight of light mineral oil; c) about4.5% by weight of stearyl alcohol; d) about 2.5% by weight of stearicacid; e) about 1.1% by weight of behenyl alcohol; f) about 4.8% byweight of minocycline hydrochloride or doxycycline hyclate; and g) about0.1% by weight of adapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 88.6% by weightof heavy mineral oil; b) about 3.6% by weight of stearyl alcohol; c)about 2.4% by weight of stearic acid; d) about 0.5% by weight of behenylalcohol; e) about 4.8% by weight of minocycline hydrochloride ordoxycycline hyclate; and f) about 0.1% by weight of adapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 50% by weight ofsoybean oil; b) about 23.6% by weight of coconut oil; c) about 5% byweight of cyclomethicone; d) about 0.7% by weight of light mineral oil;e) about 3.5% by weight of cetostearyl alcohol; f) about 3% by weight ofstearic acid; g) about 2.5% by weight of myristyl alcohol; h) about 2%by weight of hydrogenated castor oil; i) about 2% by weight of beeswax;j) about 1.5% by weight of stearyl alcohol; k) about 1.1% by weight ofbehenyl alcohol; 1) about 4.8% by weight of minocycline hydrochloride ordoxycycline hyclate; and m) about 0.3% by weight of adapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 49% by weight ofheavy mineral oil; b) about 39% by weight of light mineral oil; c) about3.8% by weight of stearyl alcohol; d) about 2.4% by weight of stearicacid; e) about 0.7% by weight of behenyl alcohol; f) about 4.8% byweight of minocycline hydrochloride or doxycycline hyclate; and g) about0.3% by weight of adapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 43.4% by weightof heavy mineral oil; b) about 39% by weight of light mineral oil; c)about 4.3% by weight of stearyl alcohol; d) about 2.5% by weight ofstearic acid; e) about 5% by weight of cyclomethicone; f) about 0.7% byweight of behenyl alcohol; g) about 4.8% by weight of minocyclinehydrochloride or doxycycline hyclate; and h) about 0.3% by weight ofadapalene.

In one or more embodiments, the hydrophobic gel or foam composition foruse in the methods provided herein comprises: a) about 45.55% by weightof light mineral oil; b) about 45.05% by weight of soybean oil; c) about4.0% by weight of stearyl alcohol; d) about 0.6% by weight of behenylalcohol; e) about 4.8% by weight of minocycline hydrochloride ordoxycycline hyclate.

In one or more embodiments, the compositions provided or describedherein comprise a carrier and a propellant. In one or more embodiments,the carrier comprises or is a hydrophobic gel or foamable compositionprovided or described herein.

In one or more embodiments, the composition is a gel, paste, lotion,cream, soap, spray, mask, patch, powder, pomade, ointment, oil, foam ormousse. In one or more embodiments, the composition is hydrophobic. Inone or more embodiments, the composition comprises hydrophobic oils andwaxes. In one or more embodiments, the composition comprises fattyalcohols. In one or more embodiments, the composition compriseshydrophobic oils and fatty alcohols. In one or more embodiments, thecomposition comprises fatty acids. In one or more embodiments, thecomposition comprises hydrophobic oils and fatty acids. In one or moreembodiments, the composition is surfactant free.

In one or more embodiments, the composition is substantially free of afatty acid or of a fatty alcohol or of a wax or any two thereof. In oneor more embodiments, the composition is essentially free of a fatty acidor of a fatty alcohol or of a wax or any two thereof. In one or moreembodiments, the composition is free of a fatty acid or of a fattyalcohol or of a wax or any two thereof.

In one or more embodiments, the hydrophobic composition comprises agelled oil. In one or more embodiments, the gelled oil is a gelledmineral oil. In one or more embodiments, the gelled mineral oil is aVERSAGEL®. VERSAGELs® are gelled oils or emollients that can come indifferent product forms including, for example, the VERSAGEL® m,VERSAGEL® p, VERSAGEL® r, and VERSAGEL® s series, and provide variousviscosity grades. There are also VERSAGELs® with isohexadecane, or withisododecane, or with hydrogenated polyisobutene, or withisopropylpalmitate. In an embodiment, it is VERSAGEL® 750 m. In anembodiment, it is VERSAGEL® 200 m. In an embodiment, it is VERSAGEL® 500m. In an embodiment, it is VERSAGEL® 1600 m. VERSAGEL® m contains amixture of mineral oil plus one or two or more of e.g.,Ethylene/Propylene/Styrene Copolymer plus e.g.,Butylene/Ethylene/Styrene Copolymer plus e.g., butylated hydroxyltoluene or similar gelling agents. In one or more embodiments, thegelled oil is at a concentration of about 55% to about 85% by weight. Inone or more embodiments, the gelled oil is at a concentration of about60% to about 80% by weight. In one or more embodiments, gelled oil is ata concentration of about 65% to about 75% by weight. In one or moreembodiments, the hydrophobic solvent is at a concentration of about 75%to about 90% by weight. In one or more embodiments, the hydrophobicsolvent is at a concentration of about 21% to about 39% by weight. Inone or more embodiments, the hydrophobic solvent is at a concentrationof about 26% to about 34% by weight. In one or more embodiments, thehydrophobic solvent is at a concentration of about 9% to about 24% byweight. In one or more embodiments, the hydrophobic solvent comprises apetrolatum at a concentration of about 9% to about 24% by weight, orabout 26% to about 34% by weight or about 21% to about 39% by weight, orabout 45% by weight, or about 50% by weight or about 55% by weight orabout 60% by weight.

Topical hydrophobic therapeutic breakable gel and foamable compositionscomprising tetracycline, including those without surfactants, have beendescribed, for example in U.S. application Ser. Nos. 13/499,501,13/499,727, 13/499,475, and 13/499,709, U.S. Publication No.2011/0281827, WO 11/039637, WO 11/039638, WO 11/138678 and WO2011/064631, all of which are herein incorporated in their entirety byreference. More particularly, any of the active ingredients, carriers,solvents, surfactants, foam adjuvants, fatty acids, fatty alcohols,polymeric agents, penetration enhancers, preservatives, humectants,moisturizers, and other excipients, as well as the propellants andmethods listed therein can be applied herein and are incorporated byreference.

Other carriers and compositions are described in: U.S. Publication No.2005/0232869, published on Oct. 20, 2005, entitled NONSTEROIDALIMMUNOMODULATING KIT AND COMPOSITION AND USES THEREOF; U.S. PublicationNo. 2005/0205086, published on Sep. 22, 2005, entitled RETINOIDIMMUNOMODULATING KIT AND COMPOSITION AND USES THEREOF; U.S. PublicationNo. 2006/0018937, published on Jan. 26, 2006, entitled STEROID KIT ANDFOAMABLE COMPOSITION AND USES THEREOF; U.S. Publication No.2005/0271596, published on Dec. 8, 2005, entitled VASOACTIVE KIT ANDCOMPOSITION AND USES THEREOF; U.S. Publication No. 2006/0269485,published on Nov. 30, 2006, entitled ANTIBIOTIC KIT AND COMPOSITION ANDUSES THEREOF; U.S. Publication No. 2007/0292355, published on Dec. 20,2007, entitled ANTI-INFECTION AUGMENTATION OF FOAMABLE COMPOSITIONS ANDKIT AND USES THEREOF; U.S. Publication No. 2008/0317679, published onDec. 25, 2008, entitled FOAMABLE COMPOSITIONS AND KITS COMPRISING ONE ORMORE OF A CHANNEL AGENT, A CHOLINERGIC AGENT, A NITRIC OXIDE DONOR, ANDRELATED AGENTS AND THEIR USES; U.S. Publication No. 2008/0044444,published on Feb. 21, 2008, entitled DICARBOXYLIC ACID FOAMABLE VEHICLEAND PHARMACEUTICAL COMPOSITIONS THEREOF; U.S. Publication No.2008/0069779, published on Mar. 20, 2008, entitled FOAMABLE VEHICLE ANDVITAMIN AND FLAVONOID PHARMACEUTICAL COMPOSITIONS THEREOF; U.S.Publication No. 2008/0206159, published on Aug. 28, 2008, entitledCOMPOSITIONS WITH MODULATING AGENTS; U.S. Publication No. 2008/0206161,published on Aug. 28, 2008, entitled QUIESCENT FOAMABLE COMPOSITIONS,STEROIDS, KITS AND USES THEREOF; U.S. Publication No. 2008/0260655,published on Oct. 23, 2008, entitled SUBSTANTIALLY NON-AQUEOUS FOAMABLEPETROLATUM BASED PHARMACEUTICAL AND COSMETIC COMPOSITIONS AND THEIRUSES; U.S. Publication No. 2011/0268665, published on Nov. 3, 2011,entitled OIL-BASED FOAMABLE CARRIERS AND FORMULATIONS; U.S. PublicationNo. 2012/0087872, published on Apr. 12, 2012, entitled FOAMABLE VEHICLESAND PHARMACEUTICAL COMPOSITIONS COMPRISING APROTIC POLAR SOLVENTS ANDUSES THEREOF; U.S. Publication No. 2012/0213709, published on Aug. 23,2012, entitled NON SURFACTANT HYDRO-ALCOHOLIC FOAMABLE COMPOSITIONS,BREAKABLE FOAMS AND THEIR USES; U.S. Publication No. 2012/0213710,published on Aug. 23, 2012, entitled SURFACE ACTIVE AGENT NON POLYMERICAGENT HYDRO-ALCOHOLIC FOAMABLE COMPOSITIONS, BREAKABLE FOAMS AND THEIRUSES; U.S. Publication No. 2013/0064777, published on Mar. 14, 2013,entitled SURFACTANT-FREE WATER-FREE FOAMABLE COMPOSITIONS, BREAKABLEFOAMS AND GELS AND THEIR USES; U.S. Publication No. 2013/0053353,published on Feb. 28, 2013, entitled COMPOSITIONS, GELS AND FOAMS WITHRHEOLOGY MODULATORS AND USES THEREOF; U.S. Publication No. 2011/0281827,published on Nov. 17, 2011, entitled COMPOSITIONS, GELS AND FOAMS WITHRHEOLOGY MODULATORS AND USES THEREOF; U.S. Publication No. 2013/0028850,published on Jan. 31, 2013, entitled TOPICAL TETRACYCLINE COMPOSITIONS;U.S. Publication No. 2013/0011342, published on Jan. 10, 2013, entitledSURFACTANT-FREE, WATER-FREE, FOAMABLE COMPOSITIONS AND BREAKABLE FOAMSAND THEIR USES; U.S. Publication No. 2013/0225536, published on Aug. 29,2013, entitled COMPOSITIONS FOR THE IMPROVED TREATMENT OF ACNE ANDRELATED DISORDERS; U.S. Publication No. 2014/0121188, published on May1, 2014, entitled METHODS FOR ACCELERATED RETURN OF SKIN INTEGRITY ANDFOR THE TREATMENT OF IMPETIGO; U.S. Publication No. 2015/0164922,published on Jun. 18, 2015, entitled USE OF TETRACYCLINE COMPOSITIONSFOR WOUND TREATMENT AND SKIN RESTORATION, all of which are incorporatedherein by reference in their entirety. More particularly, any of theactive ingredients, carriers, solvents, surfactants, foam adjuvants,polymeric agents, penetration enhancers, preservatives, humectants,moisturizers, and other excipients, as well as the propellants andmethods listed therein can be applied herein and are incorporated byreference.

Manufacture

The present disclosure also provides a method of manufacturing a gel orfoam composition having a tetracycline antibiotic, the methodcomprising: providing a composition having one or more hydrophobicsolvents; heating said composition; adding fatty alcohols, fatty acidsand waxes; cooling said composition; optionally adding SiO₂; and addinga tetracycline antibiotic.

The compositions provided herein are manufactured according to themethods described in the art and as described in Example 1. Gels areusually packaged in a tube but can also be packaged in any otherconvenient delivery form including for example, bottles with a pumpmechanism or canisters such as bag in can devices where propellant isseparate from the gel. Foam formulations are usually packed in acontainer with an outlet valve e.g., aerosol canister. Possiblecontainers and valves are likewise described in the literature as knownby those skilled in the art.

According to another aspect, both the minocycline and the foamablecompositions containing minocycline can be manufactured under currentGood Manufacturing Principles (cGMP) conditions. The foamablecomposition was provided in aluminum aerosol canisters mounted withvalve and actuator. Each canister was filled with 25 g of product and 3g of propellant. Upon actuation of the canister an aliquot of qualityfoam was released.

Administration

In one or more embodiments there is provided a method of administering atetracycline foam composition to a target area such as skin of a patientcomprising releasing foam, applying it to the area, and collapsing thefoam. In one or embodiments, the foam is applied by spreading. In thecourse of spreading mechanical shear can cause the foam to collapse. Inone or more embodiments, the collapsed foam is not washed off. In one ormore embodiments it is absorbed onto the area of skin. In one or moreembodiments it avoids skin irritation or an ointment sensation.

In one or more embodiments, there is provided a method of applying atetracycline gel composition to an area of skin of a patient comprisingreleasing a gel, applying it to the area, and collapsing or liquefyingthe gel. In one or more embodiments, the collapsed or liquefied gel isnot washed off. In one or more embodiments, the collapsed or liquefiedgel is readily absorbed and does not leave an ointment sensation.

In one or more embodiments, there is provided a method for reducing thenumber of rosacea lesions, by applying topically an effective amount ofa tetracycline gel, liquid gel or foam to an afflicted area of a patientin need. In one or more embodiments, the method involves applying a gel,liquid, gel or foam formulation topically to a target surface in need oftreatment and breaking the gel or foam over the target site. In one ormore embodiments the gel or foam is collapsed and spread by applicationof a mechanical force, which can be mild or slight such as a simple ruband the active agent is then absorbed. In one or more embodiments thefoam or gel is absorbed.

In one or more embodiments, a gel or a liquid gel or a collapsed foam isabsorbed within 240 seconds, or within 200 seconds, or within 180seconds, or within 150 seconds, within 120 seconds, or within 100seconds, or within 80 seconds, or within 60 seconds, or within 50seconds, or within 40 seconds, or within 30 seconds, or within 20seconds, or within 10 seconds, or within 5 seconds, or within 2 secondsor less. The term “absorbed” means that the composition enters onto andinto an area of skin, mucosa or eye, often forming a thin coating on thesurface.

In one or more embodiments, the method uses an additional step of precleaning and drying the lesions and surrounding area before applying thegel, liquid gel or foam.

In one or more embodiments, the method uses a sterile applicator orprior to the steps of administering and/or collapsing and/or spreading,the hands of the person spreading are sterilized in order to avoid crosscontamination.

In one or more other embodiments, the method comprises an additionalstep of applying an active agent to the lesions and surrounding areaafter the gel, liquid gel or foam has been absorbed, wherein the activeagent is a hyaluronic acid or a retinoid or BPO or salicylic acid, or analpha hydroxy acid, or azelaic acid, or nicotinamide, or a keratolyticagent, or clindamycin, or metronidazole, or doxycycline, orerythromycin, or ivermectin, or brimonidine, or sodium sulfacetamide andsulfur, or tretinoin. In some embodiments, the active agent, such as,for example, a hyaluronic acid, a retinoid, BPO, salicylic acid, analpha hydroxy acid, azelaic acid, a nicotinamide, a keratolytic agent,clindamycin, metronidazole, erythromycin, ivermectin, brimonidine,sodium sulfacetamide and sulfur, tretinoin, or mixtures of two or morethereof, is applied once daily at least 1 or 2 or 3 or 4 or 5 or 6 or 7or 8 or 9 or 10 or 11 or 12 hours after the tetracycline antibioticformulation has been absorbed. In further embodiments, the active agent,such as, for example, a hyaluronic acid or a retinoid or BPO orsalicylic acid, or an alpha hydroxy acid, or azelaic acid, ornicotinamide, or a keratolytic, or clindamycin, or metronidazole, orerythromycin, or ivermectin, or brimonidine, or sodium sulfacetamide andsulfur, or tretinoin, is applied after the third day. In yet additionalembodiments, the active agent, such as, for example, a hyaluronic acidor a retinoid or BPO or salicylic acid, or an alpha hydroxy acid, orazelaic acid, or nicotinamide, or a keratolytic agent, or clindamycin,or metronidazole, or erythromycin, or ivermectin, or brimonidine, orsodium sulfacetamide and sulfur, or tretinoin, is applied during themaintenance stage. In an alternative embodiment, the active agent, suchas, for example, a hyaluronic acid or a retinoid or BPO or salicylicacid, or an alpha hydroxy acid, or azelaic acid, or nicotinamide, or akeratolytic agent, or clindamycin, or metronidazole, or erythromycin, orivermectin, or brimonidine, or sodium sulfacetamide and sulfur, ortretinoin, is replaced with or supplemented by a steroid.

In an alternative embodiment, the active agent, such as, for example, ahyaluronic acid or a retinoid or BPO or salicylic acid, or an alphahydroxy acid, or azelaic acid, or nicotinamide, or a keratolytic agentor steroid, or clindamycin, or metronidazole, or erythromycin, orivermectin, or brimonidine, or sodium sulfacetamide and sulfur, ortretinoin, is replaced with or supplemented by an antibiotic. In anembodiment, the antibiotic, which is in addition to one or moretetracycline antibiotics, is selected from the group consisting ofmupirocin, fusidic acid, a penicillin or penicillin derivative,augmentin, an anti staphylococcal penicillin, amoxicillin/clavulanate, acephalosporin, cephalexin, a macrolide, erythromycin, clindamycin,trimethoprim-sulfamethoxazole penicillin, retapamulin, and mixtures ofany two or more thereof. In an embodiment the antibiotic is appliedtopically. In another embodiment it is applied orally or by injection orby infusion. In another embodiment more than one antibiotic is applied.For example, one is applied topically and another is given orally. Thelatter can be appropriate for example where there is a systemic as wellas a topical bacterial infection.

Frequency

In one or more embodiments there is provided a regime or regimen fortreating a patient having one or more of rosacea, and/or rosacea relatedsymptoms, and/or a tetracycline antibiotic responsive rosacea relateddisorder, and/or a tetracycline antibiotic responsive skin disorder,and/or skin disorder caused by a bacteria, and/or a tetracyclineantibiotic responsive disorder, and/or a sebaceous gland disorder, whichcomprises applying to the afflicted area on a regular basis ahydrophobic gel or foam composition, said composition comprising atherapeutically effective amount of a tetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once a day, to a surfacehaving rosacea a composition comprising a tetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, twice a day, to a surfacehaving rosacea a composition comprising a tetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, alternate-day orintermittently, to a surface having rosacea a composition comprising atetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, gradual reduction to a lowermaintenance dose, which can be increased if further outbreaks occur, toa surface having rosacea a composition comprising a tetracyclineantibiotic. In one or more embodiments, a maintenance dose can beapplied topically, daily, alternate daily, twice weekly or weekly for amonth, two months, quarterly, six months or indefinitely. A maintenancedose can include about 0.9%, or about 0.8%, or about 0.7%, or about0.6%, or about 0.5%, or about 0.4%, or about 0.3%, or about 0.2%, orabout 0.1%, or about 0.09%, or about 0.08%, or about 0.07%, or about0.06%, or about 0.05% by weight of a tetracycline antibiotic. In one ormore embodiments, the maintenance dose can be commenced after four weeksof treatment, or after five weeks of treatment, or after six weeks oftreatment, or after seven weeks of treatment, or after eight weeks oftreatment, or after nine weeks of treatment, or after ten weeks oftreatment, or after eleven weeks of treatment, or after twelve weeks oftreatment, or after thirteen weeks of treatment, or after fourteen weeksof treatment, or after fifteen weeks of treatment, or after sixteenweeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once daily for at least fourweeks, to a surface having rosacea a composition comprising atetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once daily up to four weeks,to a surface having rosacea a composition comprising a tetracyclineantibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once daily for twelve weeksor less than twelve weeks, to a surface having rosacea a compositioncomprising a tetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once daily for four weeks orless than four weeks, to a surface having rosacea a compositioncomprising a tetracycline antibiotic.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, once daily for three weeksor less than three weeks, to a surface having rosacea a compositioncomprising a tetracycline antibiotic. In one or more embodiments, thereis provided a method for treating rosacea, including administeringtopically, once daily for two weeks or less than two weeks, to a surfacehaving rosacea a composition comprising a tetracycline antibiotic

In one or more embodiments, there is provided a method for treating acondition involving inflammation of the skin or mucosa (the disorder),including administering topically, once daily for six weeks or less thansix weeks, to a surface having the disorder a gel of foam compositioncomprising a tetracycline antibiotic.

Application can be, hourly, every twelve hours (e.g., twice daily), oncedaily, alternate-day or intermittent, according to the condition of thepatient. For reasons of compliance, less frequent applications, wherepossible, are preferable, e.g., daily single applications. In certaincases, where prolonged or long term treatment is required, an initialdose is provided followed by a gradual reduction to a lower maintenancedose, which can be increased if further outbreaks occur.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a tetracycline antibiotic for use in treating oneor more of rosacea, and/or rosacea related symptoms, and/or atetracycline antibiotic responsive rosacea related disorder, and/or atetracycline antibiotic responsive skin disorder, and/or skin disordercaused by a bacteria, and/or a tetracycline antibiotic responsivedisorder, and/or a sebaceous gland disorder, including skin infections,wherein the hydrophobic gel or foam composition is administeredtopically at least alternate days or at least once daily for twelveweeks or less than twelve weeks of treatment.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a minocycline antibiotic for use in treating adisorder selected from the group consisting of rosacea, and/or rosacearelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and/or a sebaceous glanddisorder, wherein the hydrophobic gel or foam composition isadministered topically at least alternate days or at least once dailyfor at least six weeks to the skin, wherein the minocycline antibioticis the sole active ingredient present in the composition. In one or moreembodiments there is provided a hydrophobic foam composition or gelcomprising a tetracycline antibiotic for use in retarding, arresting, orreversing the progression of one or more of rosacea, and/or rosacearelated symptoms, and/or a tetracycline antibiotic responsive rosacearelated disorder, and/or a tetracycline antibiotic responsive skindisorder, and/or skin disorder caused by a bacteria, and/or atetracycline antibiotic responsive disorder, and/or a sebaceous glanddisorder, wherein the hydrophobic foam composition or gel is appliedtopically to the skin at least alternate days or at least once a day forat least six weeks.

In one or more embodiments, the method uses a once daily dosage regimefor twelve weeks or less than twelve weeks. In one or more embodimentsthe twelve-week dosage regime is followed by a once daily maintenancedose for one, two, three, four or more weeks according to the conditionand response of the patient. In one or more embodiments, the method usesa once daily dosage regime for six weeks or less than six weeks. In oneor more embodiments the six-week dosage regime is followed by a oncedaily maintenance dose for one, two, three, four or more weeks accordingto the condition and response of the patient. In one or moreembodiments, the method uses a once daily dosage regime of for six weeksor less than six weeks followed by a once weekly maintenance dose forone, two, three, four, five, six, seven, eight, nine, ten, eleven ormore weeks according to the condition and response of the patient. Inone or more embodiments, the method uses a once daily dosage regime offor three weeks or less than three weeks followed by a once weeklymaintenance dose for one, two, three, four, five, six, seven, eight,nine, ten, eleven or more weeks according to the condition and responseof the patient. In one or more embodiments, the method uses a once dailydosage regime of for two weeks followed by a daily maintenance dose forone, two, three or more weeks according to the condition and response ofthe patient. In one or more embodiments the method uses a once dailydosage regime of for twelve weeks wherein the treatment is everyalternate week.

Combination Therapy

Several disorders involve a combination of more than one etiologicalfactor; and therefore, the use of more than one active agent isadvantageous. For example, psoriasis involves excessive cellproliferation and inadequate cell differentiation as well asinflammation. Atopic dermatitis involves keratinocyte growthabnormality, skin dryness and inflammation. Bacterial, fungal and viralinfections involve pathogen colonization at the affected site andinflammation. Hence, in many cases, the inclusion of a combination ofactive agents in the pharmaceutical composition can be desirable. Thus,in one or more embodiments, the composition includes at least two activeagents, in a therapeutically effective concentration.

In one or more embodiments, a combination of any two or more of anantibacterial, an anti-inflammatory, an antifungal, and an antiviralagent is contemplated.

In one or more embodiments, a tetracycline antibiotic is the sole activeingredient present in the composition. In one or more embodiments, aminocycline is the sole active ingredient present in the composition. Inone or more embodiments, a doxycycline is the sole active ingredientpresent in the composition. In one or more embodiments minocycline anddoxycycline are used in combination.

In one or more embodiments, a combination of any two or more of aminocycline, retinoids, and benzoyl peroxide is contemplated

In one or more embodiments, a combination of any two or more of atetracycline, retinoids, and benzoyl peroxide is contemplated.

In one or more embodiments, a combination of any two or more of benzoylperoxide, antibiotics, retinoids, antiseborrheic medications,anti-androgen medications, hormonal treatments, salicylic acid, alphahydroxy acid, azelaic acid, nicotinamide, and a keratolytic agent iscontemplated. In one or more embodiments the tetracycline is combinedwith adapalene.

Disease Indications

The diseases or disorders treated by the composition provided hereininclude, for example, rosacea. Rosacea may begin as redness on thecentral face across the cheeks, nose, or forehead, but can also lesscommonly affect the neck, chest, ears, and scalp. In some cases, thesymptoms can include additional signs, such as, for example,semi-permanent redness, dilation of superficial blood vessels on theface, red domed papules (small bumps) and pustules, red gritty eyes,burning and stinging sensations, and in some advanced cases, a redlobulated nose (rhinophyma), may develop.

Rosacea may affect all ages. Based on the location, rosacea generallyhas four subtypes, three affecting the skin and the fourth affecting theeyes (ocular rosacea).

There are several subtypes of rosacea including, for example, but notlimited to, erythematotelangiectatic rosacea, papulopustular rosacea,phymatous rosacea, ocular rosacea, pyoderma faciale (also known asrosacea fulminans), rosacea conglobata, phymatous rosacea.

For the purposes of this specification, rosacea can include any of theknown subtypes, known to one of skilled in the art.

In one embodiment, rosacea is associated with the elevated levels ofcathelicidins. In another embodiment, rosacea is associated with theelevated levels of a stratum corneum tryptic enzyme (SCTE). In yetanother embodiment, rosacea is associated with parasitic mite,intestinal bacteria, or a combination thereof.

A rosacea related disorder is any disorder which can occur in parallelwith rosacea or be a contributing factor to the outbreak of rosacea orcan resemble rosacea. Perioral dermatitis is an erythematous,papulopustular facial eruption that resembles rosacea and/or acne buttypically starts around the nose. Rosacea (acne rosacea) is a chronicinflammatory disorder characterized by facial flushing, telangiectasias,erythema, papules, pustules, and in severe cases, rhinophyma.

Rosacea related symptoms include, papules, pustules, blackheads,whiteheads or milia, nodules and cysts.

Pyoderma faciale (also called rosacea fulminans) occurs suddenly on themidface of young women. It can be analogous to acne fulminans. Theeruption consists of erythematous plaques and pustules.

A number of other skin disorders and diseases can be treated with thecomposition provided herein such as rosacea, wounds, burns, inflammatoryskin dermatoses superficial infections, including skin infections, suchas impetigo, antibiotic responsive dermatoses and sebaceous glanddisorders. Minocycline can also have skin regenerating and healingproperties responsible for restoration of skin integrity. Thecombination of minocycline together with a hydrophobic solvent and afatty alcohol or fatty acid can afford a beneficial effect in conditionscharacterized, for example, by infection and/or inflammation.

Additionally, provided is a method of maintenance therapy, to preventrosacea recurrence or reduce the severity of the rosacea recurrence,applied to a patient in need which comprises applying to the skin on aregular basis (as defined above) a hydrophobic gel or foam compositioncomprising a therapeutically effective amount of a tetracyclineantibiotic

Chemical Stability, Pharmacokinetics, Safety, and Efficacy

Chemical Stability

The stability of foamable composition containing minocycline wasmonitored at 5° C., 25° C., 40° C., and 50° C. during and after theclinical trials and satisfactory stability results were obtained (see,e.g., Example 4).

Pharmacokinetics

In some embodiments, the systemic exposure of a Minocycline and/orDoxycylcine foam as disclosed herein (e.g., 1%, 1.5%, 3%, or 4%minocycline or doxycycline by weight) is equal to or lower than that ofan orally administered tetracycline (e.g., minocycline or doxycylcine),as evaluated in a PK Study. In some embodiments, the terms “systemicexposure,” “systemic absorption,” and “absorption” are usedinterchangeably.

The systemic exposure of an oral tetracycline or tetracycline foam(e.g., Minocycline or Doxycylcine foam) may be determined based on apharmacokinetic (PK) study as described in the Examples, e.g., Examples5, 6 and 9. For example, the minocycline or doxycycline foam may beadministered to a subject once or multiple times and blood samples areobtained at various time points to determine the level of minocycline ordoxycycline in plasma. Various pharmacokinetic parameters can becalculated and used as an indicator of the systemic exposure, andcompared to a control or base line (e.g., the level prior to treatmentor the level after administration of an oral tetracycline). One or moreof the following pharmacokinetic parameters may be used as an indicatorof the systemic exposure: C_(max) (maximum plasma concentration),t_(max) (time of maximum measured plasma concentration), AUC_(0-inf)(area under the plasma concentration vs time curve [AUC] from time 0 toinfinity), AUC_(0-tldc) (AUC from time 0 to the time of last detectableconcentration), t_(1/2) (terminal phase half-life), C₂₄ (minocyclineconcentration 24 hours after topical application of minocycline foam4%), AUC_(0-tau) (AUC during the 24-hour dosing interval for topicalminocycline foam), and bioavailability. At the end of the PK study, thesafety of the foam may be evaluated by surveying any treatment-emergentadverse events (TEAEs).

In some embodiments, a C_(max) value is used as an indicator of thesystemic exposure of a tetracycline (e.g., minocycline) foam describedherein. In some embodiments, an AUC_(0-inf) value is used as anindicator of the systemic exposure of a tetracycline foam describedherein. In some embodiments, an AUC_(0-tldc) value is used as anindicator of the systemic exposure of a tetracycline foam describedherein. In some embodiments, an AUC_(0-tau) value is used as anindicator of the systemic exposure of a tetracycline foam describedherein. In some embodiments, PK measurements are taken at one or moretime points following administration of a tetracycline foam describedherein, e.g., 1 hour, 6 hours, 12 hours, 18 hours, 24 hours, 36 hours,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21,22, 23, 24, 25, 26, 27, 28, 29, 30, or more days after administration,or any time period in between. In some embodiments, a tetracycline foamdescribed herein is administered about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, 14, or more days after a single dose of an oral tetracyclineand PK measurements are taken at one or more time points followingadministration of the tetracycline foam, e.g., about 1 hour, 6 hours, 12hours, 18 hours, 24 hours, 36 hours, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30,or more days after administration, or any time period in between.

In some embodiments, a 4% Doxycycline foam pharmacokinetic (PK) studysimilar to that of a 4% Minocycline foam PK Study is undertaken. In someembodiments, a 1% or 2% or 3% Doxycycline foam PK Study is similar tothat of a 1% or 2% or 3%, respectively, Minocycline foam PK Study isundertaken. In some embodiments, a 1% or 2% or 3% Minocycline foam PKStudy is similar to that of a 4%, Minocycline foam PK Study. In someembodiments the systemic exposure in a 1% or 2% or 3% Minocycline foamPK Study is lower than that of a 4% Minocycline foam PK Study. In someembodiments, a 1% or 2% or 3% Doxycycline foam PK Study is similar tothat of a 4%, Doxycycline foam PK Study. In some embodiments thesystemic exposure in a 1% or 2% or 3% Doxycycline foam PK Study is lowerthan that of a 4% Doxycycline foam PK Study.

In some embodiments, absorption of a foam described herein (e.g., a foamcomprising 1-4% tetracycline antibiotic such as doxycycline orminocycline foam or combinations thereof) is low as determined by a PKStudy in comparison to a comparable dose of an orally administeredtetracycline. In some embodiments, the C_(max) determined on Day 1 afterthe first dose is about 0.2 ng/mL to about 5 ng/mL. For example, isabout 0.2 ng/mL, or about 0.4 ng/mL, or about 0.6 ng/mL, or about 0.8ng/mL, or about 1 ng/mL, or about 1.2 ng/mL, or about 1.4 ng/mL, orabout 1.6 ng/mL, or about 1.8 ng/mL, or about 2 ng/mL, or about 2.2ng/mL, or about 2.4 ng/mL, or about 2.6 ng/mL, or about 2.8 ng/mL, orabout 3 ng/mL, or about 3.2 ng/mL, or about 3.4 ng/mL, or about 3.6ng/mL, or about 3.8 ng/mL, or about 4 ng/mL, or about 4.2 ng/mL, orabout 4.4 ng/mL, or about 4.8 ng/mL, or about 5 ng/mL.

In some embodiments, absorption of a foam described herein (e.g., a foamcomprising 1-4% tetracycline antibiotic such as doxycycline orminocycline or combinations thereof) is low as determined by a PK studyin comparison to a comparable dose of an orally administeredtetracycline. In some embodiments, a C_(max) is identified on Day 16after the administration of the foam once a day for sixteen consecutivedays and is about 0.2 ng/mL to about 12 ng/mL. For example, is about 0.2ng/mL, or about 0.4 ng/mL, or about 0.6 ng/mL, or about 0.8 ng/mL, orabout 1 ng/mL, or about 1.2 ng/mL, or about 1.4 ng/mL, or about 1.6ng/mL, or about 1.8 ng/mL, or about 2 ng/mL, or about 2.2 ng/mL, orabout 2.4 ng/mL, or about 2.6 ng/mL, or about 2.8 ng/mL, or about 3ng/mL, or about 3.2 ng/mL, or about 3.4 ng/mL, or about 3.6 ng/mL, orabout 3.8 ng/mL, or about 4 ng/mL, or about 4.2 ng/mL, or about 4.4ng/mL, or about 4.8 ng/mL, or about 5 ng/mL, or about 5.2 ng/mL, orabout 5.4 ng/mL, or about 5.6 ng/mL, or about 5.8 ng/mL, or about 6ng/mL, or about 6.2 ng/mL, or about 6.4 ng/mL, or about 6.6 ng/mL, orabout 6.8 ng/mL, or about 7 ng/mL, or about 7.2 ng/mL, or about 7.4ng/mL, or about 7.6 ng/mL, or about 7.8 ng/mL, or about 8 ng/mL, orabout 8.2 ng/mL, or about 8.4 ng/mL, or about 8.6 ng/mL, or about 8.8ng/mL, or about 9 ng/mL, or about 9.2 ng/mL, or about 9.4 ng/mL, orabout 9.6 ng/mL, or about 9.8 ng/mL, or about 10 ng/mL, or about 10.2ng/mL, or about 10.4 ng/mL, or about 10.6 ng/mL, or about 10.8 ng/mL, orabout 11 ng/mL, or about 11.2 ng/mL, or about 11.4 ng/mL, or about 11.6ng/mL, or about 11.8 ng/mL, or about 12 ng/mL.

In some embodiments, absorption of a foam described herein (e.g., a foamcomprising 1-4% tetracycline antibiotic such as doxycycline orminocycline or combinations thereof) is low as determined by a PK Studyin comparison to a comparable dose of an orally administeredtetracycline. In some embodiments, absorption is determined by a PKStudy, and a C_(max) is determined on Day 12 after the administration ofthe foam once a day for twelve consecutive days and is about 0.2 ng/mLto about 5 ng/mL. For example, is about 0.2 ng/mL, or about 0.4 ng/mL,or about 0.6 ng/mL, or about 0.8 ng/mL, or about 1 ng/mL, or about 1.1ng/mL, or about 1.2 ng/mL, or about 1.4 ng/mL, or about 1.6 ng/mL, orabout 1.8 ng/mL, or about 2 ng/mL, or about 2.2 ng/mL, or about 2.4ng/mL, or about 2.6 ng/mL, or about 2.8 ng/mL, or about 3 ng/mL, orabout 3.2 ng/mL, or about 3.4 ng/mL, or about 3.6 ng/mL, or about 3.8ng/mL, or about 4 ng/mL, or about 4.2 ng/mL, or about 4.4 ng/mL, orabout 4.8 ng/mL, or about 5 ng/mL.

In some embodiments, absorption of a foam described herein (e.g., a foamcomprising 1-4% tetracycline antibiotic such as doxycycline orminocycline or combinations thereof) is low as determined by a PK Studyin comparison to a comparable dose of an orally administeredtetracycline. In some embodiments, absorption is determined by a PKStudy, and a C_(max) is determined on Day 21 after the administration ofthe foam once a day for 21 consecutive days and is about 0.2 ng/mL toabout 5 ng/mL. For example, is about 0.2 ng/mL, or about 0.4 ng/mL, orabout 0.6 ng/mL, or about 0.8 ng/mL, or about 1 ng/mL, or about 1.1ng/mL, or about 1.2 ng/mL, or about 1.4 ng/mL, or about 1.6 ng/mL, orabout 1.8 ng/mL, or about 2 ng/mL, or about 2.2 ng/mL, or about 2.4ng/mL, or about 2.6 ng/mL, or about 2.8 ng/mL, or about 3 ng/mL, orabout 3.2 ng/mL, or about 3.4 ng/mL, or about 3.6 ng/mL, or about 3.8ng/mL, or about 4 ng/mL, or about 4.2 ng/mL, or about 4.4 ng/mL, orabout 4.8 ng/mL, or about 5 ng/mL. In some embodiments, the foam isFMX-101, 4%.

In some embodiments, absorption of a 4% tetracycline antibiotic, e.g.,minocycline or doxycycline foam as determined by a PK Study is about 800times to about 50 times lower than that of a comparable dose of an oraldoxycycline. In some embodiments, the 4% tetracycline antibiotic is acomposition described herein. In some embodiments, the 4% tetracyclineantibiotic is FMX-101, 4%, described herein. In some embodiments, a 4%tetracycline antibiotic foam described herein has about 800 times toabout 50 times lower C_(max) and/or AUC values as compared to theC_(max) and/or AUC values of a comparable dose of an oral doxycycline(e.g., an approved dose of Oracea® such as 40 mg). For example, it maybe about 800 times lower, or about 750 times lower, or about 700 timeslower, or about 650 times lower, or about 600 times lower, or about 550times lower, or about 500 times lower, or about 450 times lower, orabout 400 times lower, or about 350 times lower, or about 300 timeslower, or about 250 times lower, or about 200 times lower, or about 150times lower, or about 100 times lower, or about 50 times lower, than theC_(max) and AUC for the approved dose of the oral extended releasedoxycycline (Oracea® 40 mg).

In some embodiments, absorption of a 4% tetracycline antibiotic, e.g.,minocycline or doxycycline foam as determined by a PK Study is about 800times to about 50 times lower than that of a comparable dose of an oralminocycline. In some embodiments, the 4% tetracycline antibiotic is acomposition described herein. In some embodiments, the 4% tetracyclineantibiotic is FMX-101, 4%, described herein. In some embodiments, a 4%tetracycline antibiotic foam described herein has about 800 times toabout 25 times lower C_(max) and/or AUC values as compared to theC_(max) and/or AUC values of a comparable dose of an oral minocycline(e.g., an approved dose of SOLODYN® such as 1 mg/kg). For example, itmay be about 800 times lower, or about 750 times lower, or about 700times lower, or about 650 times lower, or about 600 times lower, orabout 550 times lower, or about 500 times lower, or about 450 timeslower, or about 400 times lower, or about 350 times lower, or about 300times lower, or about 250 times lower, or about 200 times lower, orabout 150 times lower, or about 100 times lower, or about 50 timeslower, or about 25 times lower, than the C_(max) and AUC for theapproved dose of the oral minocycline (SOLODYN® 1 mg/kg).

In some embodiments, absorption of a 4% foam tetracycline antibiotic,e.g., minocycline or doxycycline foam as determined by a PK Study isabout 850 times to about 50 times lower than that of the approved doseof an oral minocycline. In some embodiments, a 4% tetracyclineantibiotic foam described herein has about 850 times to about 50 timeslower C_(max) and/or AUC values as compared to the C_(max) and/or AUCvalues of the approved dose of an oral minocycline (e.g., Solodyn® 1mg/kg). For example, is about 850 times lower, or about 800 times lower,or about 750 times lower, or about 730 times lower or about 700 timeslower, or about 650 times lower, or about 600 times lower, or about 550times lower, or about 500 times lower, or about 450 times lower, orabout 400 times lower, or about 350 times lower, or about 300 timeslower, or about 250 times lower, or about 200 times lower, or about 150times lower, or about 100 times lower, or about 50 times lower, than theC_(max) and AUC for the approved dose of the oral extended releaseminocycline (Solodyn® 1 mg/kg).

In some embodiments, a foam described herein (e.g., a foam comprising1-4% tetracycline antibiotic such as doxycycline or minocycline orcombinations thereof, e.g., FMX-101, 4%) achieves good efficacycomparable to or better than an approved dose of an oral tetracycline(e.g., Oracea® 40 mg or Solodyn® 1 mg/kg) while avoiding systemicadverse events. In some embodiments, the foam exhibits fewer adverseevents than a comparable dose of oral tetracycline. In some embodiments,the treatment of rosecea using a composition disclosed herein issuperior to a comparable dose of the oral tetracycline while exhibitingfewer adverse events or serious adverse events and/or exhibiting lowersystemic exposure as compared to the oral tetracycline. In someembodiments, the treatment of acne using a composition disclosed hereinis superior to a comparable dose of an oral tetracycline whileexhibiting fewer adverse events and/or exhibiting lower systemicexposure as compared to the oral tetracycline (e.g., Oracea® 40 mg orSolodyn® 1 mg/kg). In some embodiments, the treatment of acne vulgarisusing a composition disclosed herein is superior to a comparable dose ofthe oral tetracycline while exhibiting fewer adverse events and/orexhibiting lower systemic exposure as compared to the oral tetracycline.

In some embodiments, the treatment of rosecea or acne using FMX-101 orFMX-103, as disclosed herein, is superior to a comparable dose of anoral tetracycline while exhibiting fewer adverse events or seriousadverse events and/or exhibiting lower systemic exposure as compared tothe oral tetracycline. In some embodiments, the treatment of acne usingFMX-101, 4% disclosed herein is superior to a comparable dose of theoral tetracycline while exhibiting fewer adverse events and/orexhibiting lower systemic exposure as compared to the oral tetracycline.In some embodiments, the treatment of acne vulgaris using FMX-101, 4%disclosed herein is superior to a comparable dose of the oraltetracycline while exhibiting fewer adverse events and/or exhibitinglower systemic exposure as compared to the oral tetracycline.

Safety

In various embodiments, clinical studies confirm that the once-dailytreatment regimen with minocycline foam (1.5% or 3%) is safe even for aprolonged treatment period. During twelve weeks of treatment, nodrug-related systemic adverse events or serious adverse events werereported, and the observed occurrences of telangiectasia,burning/stinging, or flushing/blushing resolved before the end of thestudy. Thus, administration of the minocycline topical foam isefficient, safe, and well-tolerated.

The gel, liquid gel, and foamable compositions disclosed herein meet along-felt need for a shorter treatment regimen having an earlier onsetand a higher percentage reduction in lesions, while maintaining highlevels of safety and efficacy.

Thus, provided herein in various embodiments, are methods for treatingrosacea or acne, including administering topically, to a surface havingthe disorder, a composition comprising a tetracycline antibiotic,wherein an enhanced safety and good tolerability of the topical foamableminocycline compositions is demonstrated.

In vitro skin penetration studies (see, e.g., PCT Publication No. WO11/039637) show that topical administration of minocycline bringsappreciable amounts of the drug to its target site of action (the skin),thus possibly avoiding the undesirable high systemic exposure and thenegative consequences of the oral dosage route.

The topical compositions provided herein avoid, reduce, minimize or donot cause adverse effects, which are attributed to oral tetracyclineantibiotics. Photosensitivity, for example, is a known side effect oforal minocycline. It is manifested as an exaggerated sunburn reaction onareas of the body exposed to direct sunlight or ultraviolet light,resulting in muddy brown skin discoloration. Use of oral minocyclineover an extended period of time can also lead to skin pigmentation,e.g., manifested as blue-gray skin and blue-gray staining in areas ofscarring and inflammation associated with rosacea. Tooth stainingpotential of oral minocycline in adult populations has also beenacknowledged in recent literature. In contrast, no tooth staining wasreported during the period of topical application of 1% or 4%minocycline foam or on follow-up to the study. In one or moreembodiments provided herein, the topical minocycline composition avoidstooth staining.

Topical delivery also means that lower doses can be used again,contributing to the elimination or reduction of unwanted side effects.Accordingly, the foamable compositions provided herein can be beneficialfor the treatment of a range of skin conditions, including rosacea,wounds, burns, inflammation, superficial infections, antibioticresponsive diseases or dermatoses, skin diseases caused by bacteria, andother skin infections, such as impetigo. Likewise, the foamablecompositions provided herein can be beneficial in mucosal infections andin eye infections and inflammatory conditions.

Surprisingly, it has been previously demonstrated by Applicants in U.S.Pat. No. 8,871,184, that minimal to no skin pigmentation was noticedfollowing rubbing of 4% minocycline foam onto the skin when observedafter about 30 seconds. It has been surprisingly further discovered thatno photosensitivity or skin discoloration was noticed followingapplication of 1% or 4% minocycline foam onto the skin once daily for 12weeks. Similarly, drug-related pigmentation was not observed.

Thus, the compositions provided herein can have protective properties inthe case of UVB-induced sun damage or any other condition associatedwith sunlight or other light (e.g., laser) exposure. The formulationsand methods of treatment provided herein can potentially reduce skinphoto damage and photo aging, and more generally reduce oxidative stressand inflammation in skin pathologies which are known to be accompaniedby apoptotic cell death.

It is surprisingly shown that therapeutic effects can be achieved withlow concentrations of minocycline, such as 1.5%. Thus, it is possible touse lower concentrations of minocycline, thereby reducing toxicity andincreasing safety. In some embodiments, the absolute mean lesion countchange for the 1.5% and 3% minocycline compositions is about the same.In some embodiments, the percent reduction of lesion count for the 1.5%and 3% minocycline compositions is about the same. In some embodiments,the reduction of IGA score for the 1.5% and 3% minocycline compositionsis about the same.

It is now surprisingly shown that topically administering a foamformulation having minocycline at 1.5% or 3% significantly decreases thenumber of lesions (absolute lesion count and percent change lesioncount), and also significantly improves investigator's global assessment(IGA) results (reducing the IGA score by 2 grades and reaching a “clearor “almost clear” rating) in comparison to the vehicle. Further, thedifference between the 1.5% and 3% formulations, with respect todecrease in the number of lesions and improvement of IGA score, is notstatistically significant. The efficacy of FMX103 in the treatment ofrosacea is surprising, as rosacea is a syndrome of undetermined etiologycharacterized by both vascular and papulopustular components, i.e., itis a chronic inflammatory condition of facial skin affecting both theblood vessels and pilosebaceous unit. Moreover, the observed doseindependence of effectiveness in treatment of rosacea is surprising andunexpected in light of dose dependency observed with acne, where 4%minocycline is more effective than 1% minocycline. Also, theeffectiveness in the treatment of rosacea is also surprising in view ofthe lack of bacterial involvement in rosacea, as is the case of acne andimpetigo.

It is shown herein that a topically administered foam formulationcontaining minocycline at 1.5% or 3% is safe and well tolerated. No drugrelated serious adverse events or systemic adverse events were reportedin a clinical study of the formulations. There were only a fewtreatment-related dermal reactions reported (none in the 1.5% group,three patients in the 3% group and four patients in the vehicle group).These reactions resolved before the end of the study. A total of foursubjects discontinued the study due to an adverse event (three patientsin the 3% group and one in the vehicle group).

In an embodiment, provided is a hydrophobic gel or foam compositioncomprising: a tetracycline antibiotic, wherein the tetracyclineantibiotic is present in the gel or foam composition in an amounteffective to treat rosacea in a subject, which is safe andwell-tolerated. In an embodiment, provided is a hydrophobic gel or foamcomposition comprising: a tetracycline antibiotic, wherein substantiallyno treatment-related dermal reactions are observed. In an embodiment,provided is a hydrophobic gel or foam composition comprising: atetracycline antibiotic, wherein no systemic drug-related side effectsand no serious adverse reactions are observed. In an embodiment,provided is a hydrophobic gel or foam composition comprising: atetracycline antibiotic, wherein the tetracycline antibiotic is presentin the gel or foam composition at a concentration of 1.5% or 3% to treatrosacea. In an embodiment, provided is a hydrophobic gel or foamcomposition comprising: a tetracycline antibiotic, wherein thetetracycline is minocycline hydrochloride.

In an embodiment, provided is a hydrophobic gel or foam compositioncomprising: a tetracycline antibiotic wherein the 1.5% and 3%concentrations are equally effective in reducing the number of papulesand pustules, as compared to the placebo vehicle. In another embodiment,provided is a hydrophobic gel or foam composition comprising: atetracycline antibiotic, wherein the 1.5% dose is more effective the 3%dose in reducing the number of papules and pustules, as compared to theplacebo vehicle. In another embodiment, provided is a hydrophobic gel orfoam composition comprising: a tetracycline antibiotic, wherein the 3%dose is more effective the 1.5% dose in reducing the number of papulesand pustules, as compared to the placebo vehicle. In one or moreembodiments the reduction in the papules and pustules is statisticallysignificant as compared to placebo. In one or more embodiments thereduction in the papules and pustules is statistically significant ascompared to placebo. In an embodiment, provided is a hydrophobic gel orfoam composition comprising: a tetracycline antibiotic, wherein thetetracycline is minocycline hydrochloride.

In an embodiment, provided is a hydrophobic gel or foam compositioncomprising: a tetracycline antibiotic wherein the 1.5% and 3%concentrations are equally effective in reducing IGA score by twolevels, as compared to the placebo vehicle. In another embodiment,provided is a hydrophobic gel or foam composition comprising: atetracycline antibiotic, wherein the 1.5% dose is more effective thatthe 3% dose in reducing the IGA score by two levels, as compared to theplacebo vehicle. In another embodiment, provided is a hydrophobic gel orfoam composition comprising: a tetracycline antibiotic, wherein the 3%dose is more effective the 1.5% dose in reducing the IGA score by twolevels, as compared to the placebo vehicle. In one or more embodimentsthe reduction in IGA score by two levels is statistically significant ascompared to placebo. In one or more embodiments the reduction in IGAscore by two levels results in clear or almost clear compared tobaseline. In an embodiment, provided is a hydrophobic gel or foamcomposition comprising: a tetracycline antibiotic, wherein saidtetracycline is minocycline hydrochloride.

In an embodiment, provided is a hydrophobic gel or foam compositioncomprising: a tetracycline antibiotic, wherein said tetracyclineantibiotic is present in said gel or foam composition in an amounteffective to treat moderate-to-severe papulopustular rosacea (IGA score3-4). In an embodiment, more than half of the tetracycline-treatedsubjects have severe rosacea at baseline. In an embodiment, there is nostatistical significant difference between treatment groups with regardto IGA severity at baseline.

Erythema is redness of the skin or mucous membranes, caused by hyperemia(increased blood flow) in superficial capillaries. It occurs with anyskin injury. There are different types of erythema for example erythemanodosum and erythema multiforme. Visible redness of the skin is observedin patients with medium and severe rosacea. In one or more embodiments,there is provided a method of treatment for reducing skin redness in asubject having a disorder in which one of the etiological factors isskin redness comprising applying a topical composition to an area ofskin with the disorder, wherein the topical composition comprises atetracycline antibiotic, for example, minocycline or doxycycline, at theconcentration of, for example, about 1.5% to 3%. In some embodiments,the redness is moderate redness. In some embodiments, the redness issevere redness. In some embodiments, the redness is a symptom ofRosacea. In some embodiments, it is a symptom of an infection. In someembodiments, it is a symptom of a bacterial infection. In someembodiments, it is a symptom of a fungal infection. In some embodiments,it is a symptom of a viral infection. In some embodiments, it is asymptom of an allergic reaction. In an embodiment, provided is ahydrophobic gel or foam composition comprising: a tetracyclineantibiotic wherein the 1.5% and 3% concentrations are equally effectivein reducing the severity of erythema, as compared to the placebovehicle. In another embodiment, provided is a hydrophobic gel or foamcomposition comprising: a tetracycline antibiotic, wherein the 1.5% doseis more effective than the 3% dose in reducing in reducing the severityof erythema, as compared to the placebo vehicle. In another embodiment,provided is a hydrophobic gel or foam composition comprising: atetracycline antibiotic, wherein the 3% dose is more effective than the1.5% dose in reducing the severity of erythema, as compared to theplacebo vehicle. In one or more embodiments, the reduction of erythemaseverity is statistically significant as compared to placebo. In someembodiments, a foam composition described herein is sufficient to reducethe severity of skin redness or erythema by at least 30%, 35%, 40%, 45%,50%, 55%, 60%, 65%, 70%, 75%, 80%, or more as compared to the severityof skin redness or erythema before the treatment and/or as compared to avehicle or oral doxycycline treatment. In an embodiment, provided is ahydrophobic gel or foam composition comprising: a tetracyclineantibiotic, wherein the tetracycline is minocycline hydrochloride.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having thedisorder, a composition comprising a tetracycline antibiotic, whereinessentially no skin irritation such as telangiectasia, burning/stinging,or flushing/blushing, or essentially no adverse events, or no seriousadverse events are observed. In one or more embodiments, goodtolerability was demonstrated with relatively few reports of skinirritation, such as telangiectasis, burning or stinging, flushing orblushing.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein an enhancedefficacy of the topical foamable minocycline compositions isdemonstrated.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein betterefficacy of the topical foamable minocycline compositions isdemonstrated as compared to other topical treatments.

Oral doxycycline administration may cause common side effects, includingupset stomach, nausea, diarrhea and mild headache.

Since doxycycline hyclate is a larger molecule compared to minocyclineHCl, in some embodiments it can have a reduced penetration and hence themaximum plasma concentrations can be less than those obtained forminocycline HCl.

In some embodiments, doxycycline hyclate penetrates better thanminocycline HCl and hence the maximum plasma concentrations can be morethan those obtained for minocycline HCl.

In some embodiments, doxycycline hyclate penetration is similar to thatof minocycline HCl and hence the maximum plasma concentrations can besimilar to those obtained for minocycline HCl.

Efficacy

In one or more embodiments, there is provided an effective method fortreating rosacea, as set out herein, to patients with more than twentyinflammatory lesions on the face (papules and/or pustules) and up to 2nodules, with more than twelve but not more than a nineteen inflammatorylesions on the face and no nodules, and receiving a score of at leastModerate on the Investigator's Global Assessment Scale.

In one or more embodiments, provided herein is an effective method fortreating acne using a composition described herein. In one or moreembodiments, provided herein is an effective method for treating acnevulgaris using a composition described herein. In some embodiments, thecomposition is FMX-101. In some embodiments, the composition is FMX-101,4%.

In one or more embodiments, the methods for treating rosacea, as set outherein, are able to deliver effective amounts of a tetracyclineantibiotic into the skin or mucosal surface.

In one or more embodiments, the methods for treating rosacea, as set outherein, are able to deliver effective amounts of a tetracyclineantibiotic into and around the hair follicle or the hair follicle area.

In one or more embodiments, the methods for treating rosacea, as set outherein, are able to deliver effective amounts of a tetracyclineantibiotic into or around the sebaceous gland or the sebaceous glandarea or the pilosebaceous unit.

In one or more embodiments, the methods for treating rosacea, as set outherein, are able to deliver effective amounts of a minocycline, whereinthe minocycline composition targets the sebaceous gland or the sebaceousgland area or the pilosebaceous unit.

In one or more embodiments, there is provided a method for treatingrosacea, as set out herein, wherein the hydrophobic gel or foamcomposition targets the hair follicle or the hair follicle area.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having thedisorder, a composition comprising a tetracycline antibiotic, wherein areduction in the number of lesions is observed after twelve weeks orless than twelve weeks of treatment compared to baseline. In one or moreembodiments, there is provided a method for treating rosacea, includingadministering topically, to a surface having the disorder, a compositioncomprising a tetracycline antibiotic, wherein an improvement in the skincondition is observed after twelve weeks or less than twelve weeks oftreatment and wherein an improvement is considered as restoration ofvisible, normal cutaneous topographic features, indicating the return ofskin integrity. In an embodiment the improvement is after two weeksafter three weeks, or after four weeks, or after five weeks, or aftersix weeks or after seven weeks, or after eight weeks, or after nineweeks, or after ten weeks, or after eleven weeks, or after twelve weeks.

In one or more embodiments there is provided a hydrophobic gel or foamcomposition comprising a therapeutically effective amount oftetracycline antibiotic for use in treating rosacea in a human subjectcomprising topically administering the composition at least alternatedays or at least once daily, wherein a decrease in the number of rosaceapapule and pustules is observed after at least twelve weeks oftreatment. In an embodiment the decrease in the number of rosacea papuleand pustules is after two weeks, after three weeks, or after four weeks,or after five weeks, or after six weeks or after seven weeks, or aftereight weeks, or after nine weeks, or after ten weeks, or after elevenweeks, or after twelve weeks.

In one or more embodiments, there is provided a hydrophobic gel or foamcomposition comprising a therapeutically effective amount oftetracycline antibiotic for use in treating rosacea in a human subjectcomprising topically administering the composition at least alternatedays or at least once daily, wherein a decrease the total number ofrosacea lesions is observed after at least three weeks of treatment orafter at least two weeks of treatment.

In one or more embodiments, there is provided a hydrophobic gel or foamcomposition comprising a therapeutically effective amount oftetracycline antibiotic for use in treating rosacea in a human subjectcomprising topically administering the composition at least alternatedays or at least once daily, wherein a decrease the number ofinflammatory rosacea lesions is observed after at least three weeks oftreatment or after at least two weeks of treatment.

In one or more embodiments, the human subject is 60 or less than 60years old, is 50 or less than 50 years old, is 40 or less than 40 yearsold, is 30 or less than 30 years old, or is 25 or less than 25 yearsold, or is 22 or is less than 22 years old, or is 20 or less than 20years old, or is 18 or less than 18 years old, or 15 or is less than 15years old, or is between 8 to 25 years old or is between 9 to 22 yearsold. In an embodiment the subject is a female. In an embodiment thefemale is under the age of forty-six and optionally is a pregnant orbreastfeeding female. In an embodiment the subject is a male. In anembodiment the subject is a teenager. In another embodiment the subjectis a child.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically to a surface having rosacea acomposition comprising a tetracycline antibiotic, wherein after twelveweeks of treatment, at least about 40% of the treated rosacea lesionsdisappear (in other words, a 40% decrease in the number of lesions) sothat no further antimicrobial therapy is necessary. In some embodiments,at least about 50%, at least about 60%, at least about 70% or at leastabout 80% of the treated rosacea lesions disappear. In one or moreembodiments, at least about 90% of the treated rosacea lesionsdisappear.

In other embodiments, a decrease of at least about 60% in the number ofrosacea lesions is observed after twelve weeks or less than twelve weeksof treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically to a surface having rosacea acomposition comprising a tetracycline antibiotic, wherein after twelveweeks or less than twelve weeks of treatment, at least about 45% of thetreated rosacea lesions disappear (in other words, a 45% decrease in thenumber of lesions) so that no further antimicrobial therapy isnecessary. In some embodiments, at least about 50%, at least about 60%,at least about 70% or at least about 80% of the treated rosacea lesionsdisappear after six week or less than six weeks of treatment. In one ormore embodiments, at least about 90% of the treated rosacea lesionsdisappear after twelve week or less than twelve weeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number lesions that disappeared is at least about 30%, at leastabout 40%, or at least about 50% or at least about 60%, or at leastabout 70% or at least about 75% or at least about 80% after twelve weeksor less than twelve weeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number lesions that disappeared is at least about 50%, or at leastabout 60%, or at least about 70%, or at least about 80% after four weeksafter the end of the treatment.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number lesions that disappeared at the end of treatment isstatistically significant compared to baseline in both 1.5% and 3% dosegroups.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number lesions that disappeared at the end of treatment comparedto baseline is statistically significant in both 1.5% and 3% dose groupswhen compared to placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number lesions that disappeared at the end of treatment comparedto baseline is statistically significant in the 3% dose group whencompared to placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the baselineseverity of rosacea is at least moderate to severe, as judged by thenumber of rosaceas and investigator's global severity assessment (IGA).

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the meannumber of rosacea papule and pustules at baseline is at least about30-34 or at least about 34-35.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the numberof papule and pustules is at least 20 papule and pustules. In otherembodiments there is at least one papule and pustules, or at least 5, orat least 10 or at least 15 papule and pustules and in furtherembodiments there are at least 25, or at least 30 or at least 40 or atleast 50 papule and pustules.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the rosaceais low to moderate rosacea. In other embodiments the composition can beapplied as aforesaid as a method of protecting the skin, for example, bypreventing microbial infection or rosacea

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the IGAscore as assessed by the investigator at baseline is between 3-4,indicating moderate to severe rosacea at baseline. In other embodimentsthe composition can be applied to mild rosacea and in still furtherembodiments it can be applied to very severe rosacea.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the dailyapplication of topical minocycline foam (3% and 1.5%) on facial skinwith moderate to severe rosacea results in a significant improvement ofthe disease, for example, as indicated by the primary and secondaryendpoints.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein there is aclinically and statistically significant reduction in a lesion count,after twelve weeks of treatment in the subjects receiving minocyclinefoam compared to Placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a clinicallyand statistically significant improvement in the investigator globalassessment of rosacea severity is observed after 12 treatment weeks inthe subjects receiving minocycline foam compared to Placebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a clinicallyand statistically significant improvement in the investigator globalassessment of rosacea severity is observed after 12 treatment weeks inthe subjects receiving minocycline foam compared to Placebo, and whereina clinically significant improvement in the investigator globalassessment of rosacea severity comprises improvement by at least twolevels.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the effectof the minocycline foam is dose dependent, and the effect of 3%minocycline foam is generally greater than 1.5% minocycline foam.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the effectof the minocycline foam is dose dependent, and the effect 1.5%minocycline foam is generally greater than 3% minocycline foam.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the effectof the minocycline foam on rosacea is dose independent (in a surprisingand unexpected contrast to dose dependency observed with acne), and theeffect of 1.5% minocycline foam is similar to 3% minocycline foam.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, aclinically and statistically significant reduction in the number ofinflammatory lesions can be seen after 12 weeks of treatment in subjectsreceiving the 1.5-3%, or about 1.5% or about 3% minocycline foam, ascompared to Placebo and/or compared to baseline prior to treatment.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, more than a60% reduction in inflammatory lesion counts can be seen following twelveweeks of treatment in subjects receiving the 1.5-3% minocycline foamcompared to Placebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, the percentof subjects who had a decrease of more than 40%, 50%, 60%, or 70% in theinflammatory lesions count was statistically significantly higher in the1.5-3% treatment group compared to Placebo after 6 treatment weeks andonward.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, the percentof subjects who had a decrease of more than 50% or 60%, in theinflammatory lesions count was statistically significantly higher in the1.5-3% treatment group compared to Placebo only at twelve treatmentweeks.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment at 12 weeks, more than 20% of thesubjects have “clear” or “almost clear” skin in subjects receiving the1.5-3% minocycline foam and wherein this change is statisticallysignificant compared to subjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment at 12 weeks, the number of thesubjects having “severe” or “moderate” rosacea has decreased at least50% in subjects receiving the 1.5-3% minocycline foam and wherein thischange is statistically significant compared to subjects in the Placebogroup.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment at 12 weeks, the number of thesubjects having “severe” or “moderate” rosacea has decreased at least60% in subjects receiving the 1.5-3% minocycline foam and wherein thischange is statistically significant compared to subjects in the Placebogroup.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment at 12 weeks, the number of thesubjects having “severe” or “moderate” rosacea has decreased at least70% in subjects receiving the 1.5-3% minocycline foam and wherein thischange is statistically significant compared to subjects in the Placebogroup.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment at 12 weeks, the number of thesubjects having “severe” rosacea has decreased at least 50% in subjectsreceiving the 1.5-3% minocycline foam and wherein this change isstatistically significant compared to subjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment at 12 weeks, the number of thesubjects having “severe” rosacea has decreased at least 60% in subjectsreceiving the 1.5-3% minocycline foam and wherein this change isstatistically significant compared to subjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment at 12 weeks, the number of thesubjects having improvement is statistically significantly higher in the1.5-3% treatment group compared to Placebo after 8 treatment weeks andonward.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment at 12 weeks, the number of thesubjects having improvement by of at least 2 grades is statisticallysignificantly higher in the 1.5-3% treatment group compared to Placeboafter 12 treatment weeks and onward.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein improvementof at least 2 grades in the investigator's global assessment score isobserved in at least 20% of the subjects receiving 1.5-3% minocyclinefoam and wherein this is statistically more frequent than in subjectsreceiving Placebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein improvementof at least 2 grades in the investigator's global assessment score is inat least 15% of the subjects receiving 1.5-3% minocycline foam andwherein this is statistically more frequent than in subjects receivingPlacebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein improvementof at least 3 grades in the investigator's global assessment score is inat least 10% of the subjects receiving 1.5-3% minocycline foam andwherein this is statistically more frequent than in subjects receivingPlacebo.

In one or more embodiments, provided is a method for treating rosacea,including administering topically, to a surface having rosacea, acomposition comprising a tetracycline antibiotic, wherein according tosecondary endpoint relating to rosacea improvement, assessment by theinvestigator after twelve weeks of treatment indicates improvement in atleast 70% of subjects receiving the 1.5-3% minocycline foam, whereinthis is statistically significant compared to the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tosecondary endpoint relating to rosacea improvement assessment by theinvestigator after 12 treatment weeks indicates improvement in at least60% of subjects in subjects receiving the 1.5-3% minocycline foam andwherein this is statistically significant compared to the Placebo group.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein at leasthalf the subjects receiving the 1.5-3% minocycline foam evaluated theirrosacea as ‘much better than prior to study’ and wherein this isstatistically significant when compared to the Placebo group.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein the effectwas most notably shown on severe rosacea subjects receiving the 1.5-3%minocycline foam.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions and that disappeared at the end oftreatment compared to baseline is higher than placebo in both 1.5% and3% dose groups.

In one or more embodiments, the placebo formulation has a beneficialeffect. In one or more embodiments there is provided a method fortreating rosacea, including administering topically, to a surface havingrosacea, a placebo composition being a vehicle composition describedherein for the delivery of a tetracycline that does not comprise atetracycline antibiotic, wherein a percent of number of inflammatorylesions that disappeared at the end of treatment compared to baseline ishigher than on a surface having rosacea that is untreated. In oneembodiment placebo is statistically better than no treatment.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions that disappeared in the 3% dosegroup at the end of treatment is significantly statistically higher thanthat of the 1.5% dose group.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions that disappeared in the 1.5% dosegroup at the end of treatment is significantly statistically higher thanthat of the 3% dose group.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions that disappeared in the 3% dosegroup at the end of treatment is significantly statistically higher thanthat of placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions that disappeared in the 1.5% dosegroup at the end of treatment is significantly statistically higher thanthat of placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein a percent oftotal number of inflammatory lesions that disappeared in both 1.5% and3% dose groups at the end of treatment is statistically significant whencompared to placebo.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein at leastabout 30%, or at least about 40%, or at least about 50%, or at leastabout 55%, or at least about 58%, or at least about 60%, or at leastabout 62%, or at least about 70%, or at least about 75% of total numberof inflammatory lesions disappear after twelve weeks after the end ofthe treatment (F/U). In one or more embodiments these changes at F/U arestatistically significant compared to baseline in both 1.5% and 3% dosegroups. In one or more embodiments these changes at F/U arestatistically significant compared to placebo in both 1.5% and 3% dosegroups. In one or more embodiments the number of inflammatory lesions atF/U is the same or similar compared to end of treatment (“EOT”) in both1.5% and 3% dose groups. In one or more embodiments the number ofinflammatory lesions at F/U increases compared to EOT. In one or moreembodiments there is the number of inflammatory lesions at F/U decreasescompared to EOT.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment of erythema at 12 weeks, more than15% of the subjects have “clear” or “almost clear” skin in subjectsreceiving the 1.5-3% minocycline foam and wherein this change isstatistically significant compared to subjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment of erythema at 12 weeks, more than10% of the subjects have “clear” or “almost clear” skin in subjectsreceiving the 1.5-3% minocycline foam and wherein this change isstatistically significant compared to subjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment of erythema at 12 weeks, thenumber of the subjects having “severe” or “moderate” rosacea hasdecreased at least 70% in subjects receiving the 1.5-3% minocycline foamand wherein this change is statistically significant compared tosubjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment of erythema at 12 weeks, thenumber of the subjects having “severe” or “moderate” rosacea hasdecreased at least 50% in subjects receiving the 1.5-3% minocycline foamand wherein this change is statistically significant compared tosubjects in the Placebo group.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment of erythema at 12 weeks, thenumber of the subjects having “severe” rosacea has decreased at least70% in subjects receiving the 1.5-3% minocycline foam and wherein thischange is statistically significant compared to subjects in the Placebogroup.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein, accordingto the investigator's global assessment of erythema at 12 weeks, thenumber of the subjects having “severe” rosacea has decreased at least80% in subjects receiving the 1.5-3% minocycline foam and wherein thischange is statistically significant compared to subjects in the Placebogroup.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment of erythema at 12 weeks, the numberof the subjects having improvement by of at least 2 grades isstatistically significantly higher in the 1.5-3% treatment groupcompared to Placebo after 12 treatment weeks and onward.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment of erythema at 12 weeks, the numberof the subjects having improvement by of at least 2 grades is in atleast 10% of the subjects receiving 1.5-3% minocycline foam and whereinthis is statistically more frequent than in subjects receiving Placebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein according tothe investigator's global assessment of erythema at 12 weeks, the numberof the subjects having improvement by of at least 2 grades is in atleast 15% of the subjects receiving 1.5-3% minocycline foam and whereinthis is statistically more frequent than in subjects receiving Placebo.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results in no adverse event.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein at treatingsaid rosacea in said subject results in more than about 30% reduction inlesions, relative to placebo, after about two to twelve weeks oftreatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results about 30-60% reduction in lesions,relative to placebo, after about two to twelve weeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea, in said subject, with said composition having 1.5% or 3%minocycline, results in about 33% reduction in the incidence oferythema, relative to 7% reduction in placebo, after two weeks oftreatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea, in said subject, with said composition having 1.5% or 3%minocycline, results in a significant reduction in papules and pustules,relative to placebo, after about two to twelve weeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results in reduction in the number oflesions ranging from about 10 to about 30, relative to a baseline.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results in reduction in the number oflesions of about 10, 15, 20, or 30, relative to a baseline.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea, in said subject, with said composition having 1.5% or 3%minocycline, results reduction in the number of lesions of about 19-22,relative to placebo, after about two to twelve weeks of treatment.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results in lesion count ranging from about10 to about 20.

In one or more embodiments, there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic, wherein treatingsaid rosacea in said subject results in lesion count of about 10, 13,14, 15, 18, or 20.

As with other therapeutic regimens, patient compliance is essential inthe effectiveness of prescribed antibiotics. With poor compliance,therapeutic goals are less likely to be achieved, resulting in poorerpatient outcomes. Poor compliance is associated with deteriorating skincondition, the need for additional consultations, the emergence ofbacterial resistance, extra drugs, additional expenses on cosmeticiansand increases in direct and indirect costs of healthcare management.

In general, patients are more compliant with simple and shorter dosingregimens. Both the dosage schedule and the patient's daily routineshould be considered when prescribing antibiotics. Topical agents canalso be more attractive than oral therapy because they reduce thepotential for systemic side effects, typically nausea and diarrhea,which are commonly associated with many systemic antibiotics. They canalso help provide a reduction in cross contamination by providing abarrier with antibiotic over the infected area.

In one or more embodiments there is provided a method for treatingrosacea, including administering topically, to a surface having rosacea,a composition comprising a tetracycline antibiotic administered at leastalternate days or once daily which has a high or improved patientcompliance compared with existing treatments.

In one or more embodiments, one or more of the methods provided hereinfor treating or alleviating rosacea or acne can also be used fortreating a disorder including one or more of the following: rosacearelated or associated disorder, rosacea-like symptoms, rosacea relatedsymptoms, a tetracycline antibiotic responsive rosacea related disorder,skin disorder caused by a bacteria, and a tetracycline antibioticresponsive sebaceous gland disease.

A multi-center, randomized, double blind, placebo controlled, parallelgroup, dose finding Phase II clinical study conducted in patientsafflicted with papulopustular rosacea is reported in Example 3 below.The study is designed to assess the efficacy, safety and tolerability offoamable composition comprising minocycline at one of two differentconcentrations (strengths): a lower concentration of minocycline of 1.5%by weight of the formulation and higher concentration of minocycline 3%by weight of the formulation, in comparison with a placebo. Theconcentrations of minocycline in the composition were selected accordingto formulation integrity and stability considerations.

In some embodiments similar Phase II clinical studies for additionaltetracycline antibiotic formulations such as DOX331, DOX332, DOD-003,MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058 are undertaken.

In some embodiments, Phase II studies in rosacea for other tetracyclineantibiotic formulations (such as DOX331, DOX332, DOD-003, MCD-037,MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058) provide similar resultsto those seen for the FMX103 formulation.

In some embodiments, a Phase II clinical study indicates that othertetracycline antibiotic formulations (such as DOX331, DOX332, DOD-003,MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058) can treatmoderate-to-severe rosacea.

In some embodiments, a Phase II clinical study for another tetracyclineantibiotic formulation such as DOX331, DOX332, DOD-003, MCD-037,MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058 indicates that such aformulation can reduce papules and pustules in rosacea patients.

In some embodiments, DOX331, DOX332, DOD-003, MCD-037, MCD-045, MCD-052MCD-053, MCD-065 and MCD-058 can help patients having rosacea. In someembodiments, DOX331, DOX332, DOD-003, MCD-037, MCD-045, MCD-052 MCD-053,MCD-065 and MCD-058 are safe and well tolerated in subjects who haverosacea. In some embodiments there are no drug-related systemic sideeffects. DOX331, DOX332, DOD-003, MCD-037, MCD-045, MCD-052 MCD-053,MCD-065 and MCD-058 are in some embodiments superior to a vehicle inpreventing rosacea. In some embodiments, compliance with DOX331, DOX332,DOD-003, MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058 is high.In some embodiments application with one or more of topical DOX331,DOX332, DOD-003, MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058can improve patients' quality of life

In some embodiments, other tetracycline antibiotic formulations (such asDOX331, DOX332, DOD-003, MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 andMCD-058) are safe and well-tolerated in the subjects having rosacea. Insome embodiments no systemic drug-related adverse events are recorded.

The compositions and methods provided herein are described withreference to the following examples, in a non-limiting manner. Thefollowing examples exemplify the foamable compositions and methodsdescribed herein. The examples are for the purposes of illustration onlyand are not intended to be limiting. Many variations will suggestthemselves and are within the full intended scope.

EXAMPLES

-   -   In one or more embodiments, the amounts in the examples should        be read with the prefix “about.”

As used herein, the term “NM” means not measured.

Exemplary Ingredients Suitable for the Production of FoamableCompositions

Chemical Name Function Commercial Name Supplier Beeswax white FoamBeeswax white STRAHL & PITSCH, Inc. Stabilizer Behenyl alcohol FoamLanette 22 BASF Stabilizer Cetostearyl alcohol Foam Kolliwax ® CSA 50BASF Stabilizer Coconut oil Carrier Coconut oil Henry LamotteCyclomethicone-5 Carrier ST-cyclomethicone-5 Dow Hydrogenated castor oilFoam Kolliwax ® HCO BASF Stabilizer Light Mineral Oil Carrier Pionier2076P Hansen & Rosenthal Light Mineral Oil 15 Columbia Petro ChemPVT.LTD. Minocycline HCl Active agent Minocycline HCl Hovione Myristylalcohol Foam Kolliwax ® MA BASF Stabilizer Propane/Isobutane/ButanePropellant AP-70 Aeropress (55:18:27) Soybean oil Carrier Soybean oilHenry Lamotte Stearic acid Foam Kolliwax ® S Fine BASF StabilizerStearyl Alcohol Foam Kolliwax ® SA BASF Stabilizer

Example 1 General Manufacturing Procedures for a Gel or a Foam

The following procedures were used to produce gel or foam samples, inwhich only the steps relevant to each formulation were performeddepending on the type and nature of ingredients used.

Step 1: Hydrophobic solvents such as mineral oils are mixed at roomtemperature. Others solvents such as silicones, if present, are added atroom temperature under mixing until formulation homogeneity is obtained.

Step 2: The formulation is warmed to 70-80° C. or 80-90° C. and solidcompounds such as fatty alcohols, fatty acids and waxes are added andmixed until complete dissolution.

Step 3: The formulation is cooled down to 30-40° C. Silica dioxide(SiO₂), if present, and active agents such as tetracyclines are addedunder mixing until formulation homogeneity is obtained.

Step 4: For gel compositions, the formulation is packaged in suitablecontainers. For foamable compositions, the formulation is packaged inaerosol canisters which are crimped with a valve, pressurized withpropellant and equipped with an actuator suitable for foam dispensing.Optionally, a metered dosage unit can is utilized to achieve delivery ofdesirable and/or repeatable measured doses of foam.

Step 5: For foamable compositions, pressurizing is carried out using ahydrocarbon gas or gas mixture. Canisters are filled and then warmed for30 seconds in a warm bath at 50° C. and well shaken immediatelythereafter.

Step 6: The canisters or containers are labeled.

Example 2 General Manufacturing Procedures for a Gel or a Foam

The following procedures are used to produce gel or foam samples, inwhich only the steps relevant to each formulation are performeddepending on the type and nature of ingredients used.

Step 1: Hydrophobic solvents and solid compounds such as fatty alcohols,fatty acids and waxes are mixed and heated to a temperature sufficientto achieve complete dissolution.

Step 2: The formulation is cooled down to 35-40° C., sensitivecomponents such as silica dioxide (SiO₂), if present, cyclomethicone andsensitive active agents such as tetracyclines are added under mixinguntil formulation homogeneity is obtained.

Step 3: The formulation is cooled down to room temperature.

Step 4: For gel compositions, the formulation is packaged in suitablecontainers. For foamable compositions, the formulation is packaged inaerosol canisters which are crimped with a valve, pressurized withpropellant and equipped with an actuator suitable for foam dispensing.

Step 5: For foamable compositions, pressurizing is carried out using ahydrocarbon gas or gas mixture. The canisters or containers are labeled.

In one or more embodiments, part of the hydrophobic solvents are addedduring the cooling process of the formulation (step 2).

In one or more embodiments, one of more of the formulation mixing stepscan be done with or without vacuum and in the presence or absence ofair, or an inert gas. For example, in an embodiment, one or more stepsare done under vacuum, in the absence of air under an inert gas.

In one or more embodiments, likewise packaging in canisters can be donewith or without vacuum and in the presence or absence of air, or aninert gas.

Example 3 Clinical Study Phase II (1.5% or 3% Minocycline Foam)

Study Title:

A Randomized, Multicenter, Double-blind, Vehicle-controlled Study toEvaluate the Safety and Efficacy of two Different Doses of a TopicalMinocycline Foam Compared to Vehicle in the Treatment of PapulopustularRosacea.

Study Synopsis:

In this example, topical administration of tetracycline (for exampleminocycline) is studied and the safety and efficacy of two differentdoses of minocycline foam compared to vehicle foam are evaluated in thetreatment of moderate-to-severe papulopustular rosacea.

Objectives:

The primary objective of the study is to evaluate the efficacy of twodifferent doses of FMX-103 minocycline foam compared to vehicle foam insubjects with moderate-to-severe papulopustular rosacea. The secondaryobjectives of the study are (a) to determine the relationship betweenthe concentration(s) of topical minocycline foam and treatment response,(b) sensitivity analyses of efficacy of two different doses of FMX-103minocycline foam compared to vehicle foam in subjects withmoderate-to-severe papulopustular rosacea, and (c) to evaluate thesafety and tolerability of topical minocycline foam applied daily for 12weeks.

Study Medication:

Table 2. FMX103 Minocycline (3% and 1.5%) and placebo foamablecompositions without silicone dioxide (SiO₂), as described in Table 4.

Dosage:

Dosage form Foam containing minocycline, 1.5% and 3% description Vehiclefoam (0%) Package Canisters, each containing 35gr of the clinical trialdescription supply foam either: vehicle; FMX-103 1.5% minocycline foam;or FMX- 103 3% minocycline foam Daily dose Once daily application of asmall amount of study drug (a diameter of a one cent coin/~1.5 cm) ontofingertip to cover the entire face. Estimated maximum is 0.5 gr of thefoam containing 7.5 (1.5%) or 15 (3%) mg of minocycline Cumulative 630mg (1.5%) or 1,260 mg (3%) maximal dose for dosing (12 weeks) Dispensing1 canister containing 35 g of the FMX-103 minocycline formulation, 1.5%or 3% or vehicle dispensed at Visit 2 (Baseline), Visit 4, Visit 5, andoptionally at other visits if required.

Indication:

Papulopustular rosacea.

Design:

A randomized, multicenter, double-blind, vehicle-controlled studyassessing 232 male or non-pregnant female subjects aged greater than orequal to 18 years with a clinical diagnosis of moderate-to-severepapulopustular rosacea for at least 6 months, with at least 12inflammatory facial lesions (i.e., papules/pustules).

Patients:

The study enrolls 210 male or female patients (approximately 70 subjectsper arm: control, 1.5% and 3% minocycline) at approximately 14-16 sitesin Germany who meet all of the inclusion criteria (Table 1) and none ofthe exclusion criteria (Table 2).

TABLE 1 Inclusion criteria ≥18 years-of-age with moderate-to-severerosacea (as per IGA) on the proposed facial treatment. area consistingat least 12 facial papules or pustules excluding papule and pustule sinvolving the eyes and scalp. Diagnosed with rosacea for at least 6months prior to screening Women of child-bearing potential must have anegative serum pregnancy test and agree to use a highly effective methodof contraception. Willing to minimize external factors that mighttrigger rosacea flare-ups (e.g., spicy foods, thermally hot foods anddrinks, hot environments, prolonged sun exposure and extensive alcoholicbeverages). Subjects who use make-up must have used the samebrands/types of make-up for a minimum period of 14 days prior to studyentry and must agree to use the same make-up, brand/type, or frequencyof use, throughout the study. Completed and signed an appropriatelyadministered Informed Consent Form (ICF) prior to any study-relatedprocedures.

TABLE 2 Exclusion Criteria Pregnancy or breastfeeding. Any skincondition on the face that would interfere with the diagnosis orassessment of rosacea. Moderate or severe rhinophyma, densetelangiectasis (score 3, severe), or plaque-like facial edema. An activenodule on the face >5 mm in diameter. Excessive facial hair. History ofhypersensitivity or allergy to minocycline, any other tetracycline orany other component of the formulation. Severe irritation grade forerythema, dryness, scaling, pruritus, stinging/burning, and edema.Rosacea conglobata or fulminans, corticosteroid-induced rosacea orisolated pustulosis of the chin, facial erythrosis of known origin otherthan rosacea (e.g., known carcinoid syndrome). Ocular rosacea (e.g.,conjunctivitis, blepharitis, or keratitis) Use within 6 months prior tobaseline of oral retinoids. Woman of childbearing potential who has useda highly effective method of contraception for less than 3 months priorto baseline. Use within 1 month prior to baseline of topical retinoidsto the face or systemic antibiotics known to have an impact on theseverity of papulopustular rosacea or systemic corticosteroids ormethoxyflurane. Use within 2 weeks prior to baseline of: topicalcorticosteroids, or topical antibiotics in the head and neck area;topical medications for rosacea. Wax epilation of the face within 2weeks prior to Baseline and during the study. use of sauna during the 2weeks prior to Baseline and during the study. Bacterial folliculitis.Alcohol or drug abuse Excessive or prolonged exposure to weatherextremes Any other clinically significant condition or situation thatmay interfere with the study evaluations Uncontrolled/instable relevantarterial hypertension Participating in another investigational drugstudy within 30 days prior to Baseline Previously enrolled in theFX2015-10 study Prior laser therapy to the facial area within 3 monthsprior to Baseline. Prior cosmetic procedures which may affect theefficacy and safety profile within 2 weeks prior to Baseline

Clinical Study Design

Eligible subjects are assigned to 1 of 3 treatments (vehicle, 1.5% and3% minocycline) at 1:1:1 ratio according to the randomization schedule.Subjects are to apply the study drug topically once daily for 12 weeksas directed. Subjects are advised to use the study drug at approximatelythe same times each day in the evening. Both the investigator andsubject are blinded to the study drug identity.

Subjects return for visits at Weeks, 2, 4, 8, 12, and 16. Efficacyevaluations (Investigator's Global Assessment [IGA] score andinflammatory papule and pustule counts) are performed at Weeks, 2, 4, 8,and 12 during the study, with an additional safety follow-up visit atweek 16. Other assessments are performed as described in the Study FlowChart (Table 3).

The dosing regimen is the same for all treatment groups. All patientsreceive at Screening Visit a guideline with detailed instructions on howto apply the medication correctly. In addition, patients are asked ateach study visit about their medication application to assure a correctuse of study medication.

Study drug kits are dispensed at Visit 2 (Baseline), Visit 4 (Week 4),Visit 5 (Week 8), and optionally at other/unscheduled visits if requiredfor continuous dosing.

A small amount of study drug (a diameter of a one-cent coin) should beexpressed from the canister onto the thoroughly washed finger tips andthen applied topically as a thin layer over all parts of the face.

TABLE 3 Study Flow Chart Final main Follow protocol up AssessmentScreening Baseline^(a) Visits Visit^(b) visit^(f) Visit 1 2 3 4 5  6  7Week 2 4 8 12 16 −3/+5 d −3/+5 d −3/+5 d −3/+5 d −3/+5 d InformedConsent X Demographic Data X Assign subject X identificationMedical/Surgical/ X Medication History Inclusion/Exclusion X X criteriaPhysical Exam, height, X X weight^(c) Blood Pressure/heart rate^(d) X XX X X X Blood and urine samples X X for clinical laboratory tests Urinepregnancy test X X X X (females only) Serum pregnancy test X X (femalesonly) Papule and pustule Count X X X X X X Investigator’s Global X X X XX X Assessment Modified IGA X X X X X X RosaQoL assessment X XRandomization X Photography of face X X X X X Concomitant Medication X XX X X X Adverse Events X X X X X X Local safety assessments X X X X XAssessments of erythema X X X X X X Perform drug X^(e) X X Xaccountability Collect empty drug X X X canister(s) Dispense Study DrugX X X Handout of Patient's X Guidelines Schedule/Confirm Next X X X X XX Visit ^(a)Baseline must occur within 6 weeks of screening. Bloodresults must not show clinically significant abnormalities. ^(b)If asubject prematurely withdraws from the study, all evaluations describedunder Visit 6/Week 12 must be performed. ^(c)Height to be measured onlyat Baseline. ^(d)Measure blood pressure and heart rate after the subjecthas been sitting for at least 5 minutes at rest. ^(e)The canister ofstudy drug has to be weighed and given back to the patient. ^(f)Ifpatient is unable to come to the visit there should be at least afollow-up phone call.

Efficacy

The efficacy assessments include the lesion counts and IGA at Baselineand Weeks 2, 4, 8, and 12. The primary efficacy endpoint is the absolutechange in inflammatory lesion count at Week 12 compared to Baseline.Lesion count is performed by the investigator. The number of papules,pustules and nodules are counted and the numbers recorded. The facialarea lesion counts are made for the forehead, left and right cheeks,nose and chin at each visit.

Secondary Efficacy Assessments are performed by the investigator whoassesses the global severity of rosacea at Screening, Baseline, Weeks 2,4, 8, and 12 by grading the severity on a 0-4 scale, with score 0corresponding to “clear”, and score 1 corresponding to “almost clear”.Severity Assessment of other Rosacea Criteria will include gradingErythema of the face on a 0-4 scale, patient self-grading of Rosaceaquality of life index (RosaQoL), and evaluation of standardizedphotographs.

Patient Demographics:

Patient demographics can include the individuals with diverse group,gender, height, weight and body mass index (BMI).

Statistical Methodology

All statistical analyses are performed using SAS® software version 9.3(or higher). Descriptive statistics for qualitative variables (e.g.,race) include the number and percentage of subjects with the qualitativeresponse. For quantitative variables (e.g., age), descriptive statisticsinclude the number of subjects with non-missing data, mean, standarddeviation, median, and minimum and maximum values. All hypothesistesting is conducted using two-sided tests with α=0.05 level ofsignificance. Each minocycline dose group are compared to vehicle,however, the primary comparison is the minocycline 3% treatment groupversus the vehicle treatment group.

The Intent-to-treat (ITT) analysis population includes all randomizedsubjects. The ITT population is primary for all efficacy analyses.

The Per-protocol (PP) population includes all subjects in the ITTpopulation who had at least one post-Baseline assessment, and arewithout any other major deviations from the protocol that can have animpact on the efficacy assessments and subjects are analyzed as treated.The PP population is secondary for all efficacy analyses.

The Safety population includes all randomized subjects who received atleast one application of study medication. Subjects who have nopost-Baseline assessments are included in the Safety population unlessall dispensed study drug is returned. All safety analyses are performedon the Safety population.

Clinical Response to Treatment Escape Criteria (for Success andFailure):

Success

The primary efficacy endpoint is the absolute change in inflammatorylesion count at Week 12 compared to Baseline.

The secondary efficacy endpoints are, hierarchically: the dichotomizedIGA score where success is defined as a two-step drop in score at Week12 compared to Baseline; the dichotomized IGA score where success isdefined as a two-step drop resulting in a 0 or 1 score at Week 12compared to Baseline; percent change in inflammatory lesion count atWeek 12 compared to Baseline; the dichotomized mIGA score where successis defined as a two-step drop resulting in a 0 or 1 score at Week 12compared to Baseline.

The null hypotheses of the equality of each active treatment mean to thevehicle treatment mean for absolute change from Baseline to Week 12 inthe inflammatory lesion count is tested using an Analysis of Covariance(ANCOVA) with treatment as a main effect, investigational site as ablocking factor, and Baseline inflammatory lesion count as a (linear)covariate. Treatment by (pooled) investigational site interaction istested separately at 0.1 level of significance. The primary comparisonis between the 3% minocycline treatment group and vehicle. Secondarycomparison is made between the 1.5% minocycline treatment group andvehicle. The assumptions of normality and homogeneity of variance fromthe ANCOVA model are tested at 0.05 level of significance.

This analysis is performed for the 3% minocycline group versus vehicleand, if significant, is repeated for the 1.5% minocycline group versusvehicle.

Secondary dichotomized endpoints of IGA success rates at Week 12 aretested using Cochran-Mantel-Haenszel (CMH) test (row mean scores)stratified by investigational site. Comparisons of 3% minocycline versusvehicle and 1.5% minocycline versus vehicle are done using only datafrom the pair of treatments being compared. Continuous endpoints areanalyzed using an ANCOVA model with treatment as a main effect, Baselineand (pooled) investigational site as covariates.

Other secondary endpoints are tested in the order listed above, wherethe 3% minocycline is compared to vehicle, then the 1.5% minocycline iscompared to vehicle on the same secondary endpoint.

Sub-group analyses by gender, age (18-30, 31-50, >50), Baseline lesioncount (≤34, 35-75). Other cut-off by baseline lesion counts may beexplored. Other important demographic and baseline characteristicssub-groups analyses are conducted. Summaries of primary and importantsecondary endpoints are done by investigational site.

Safety Tolerability and Adverse Events

The safety assessments in this study are standard safety measures inclinical studies, including physical examinations, vital signs (bloodpressure, heart rate), local safety assessment scores (telangiectasis,burning/stinging, and flushing/blushing), questioning on Adverse events(AEs) and serious AEs (SAES) (volunteered, observed, and elicited bygeneral questioning), and clinical laboratory test results (serumchemistry, hematology, urinalysis). The severity of each of thefollowing signs/symptoms is measured by an investigator at Baseline andat Weeks 2, 4, 8 and 12: telangiectasis, burning/stinging, andflushing/blushing, all scored on a 1-5 scale. The score for signs isdetermined by the investigator and must represent the subject'scondition at the time of the evaluation. The score for symptoms,burning/stinging and flushing/blushing, should be scored based on thesubject's symptoms reported for the previous three days.

A complete relevant medical and surgical history is obtained atScreening Visit, which will include diseases of the head, ears, eyes,nose and throat, respiratory diseases, cardiovascular diseases,gastrointestinal diseases, hepatic diseases, genitourinary diseases,musculoskeletal diseases, endocrine diseases, neurological diseases,psychiatric diseases, skin diseases, allergies, hematological diseases,and other abnormalities.

Other safety evaluation points will include a history of medicationusage (including previous use of acne medications and non-medicationtherapies) and all medication that the subject is currently taking orany change in medication or dosage since the last visit are documentedthroughout the study.

Safety assessments will include recording adverse events (AEs) reportedspontaneously by the subject or observed by the investigator. An AdverseEvent (AE) is any unfavorable or unintended sign, symptom, or diseasethat appears or worsens in a subject after the subject signs the ICF(and/or Assent Form) for a clinical study. AEs are recorded at eachvisit throughout the study on the appropriate CRF.

In one or more embodiments, similar clinical studies can be conductedfor any tetracycline formulations described herein, such as DOX331,DOX332, DOD-003, MCD-037, MCD-045, MCD-052 MCD-053, MCD-065 and MCD-058.

Compositions

The below compositions, for use in the clinical study, are preparedaccording to the manufacturing procedures detailed in Example 1.

TABLE 4 FMX103 Minocycline (3% and 1.5%) and placebo Foamablecompositions without silicone dioxide (SiO₂) 3% Minocycline 1.5%Minocycline Placebo Quantitative Quantitative Quantitative CASComposition (% Composition (% Composition (% Number w/w) w/w) w/w)Minocycline HCl (expressed as 13614987 3.00^(a) 1.50^(a) — minocycline)Soybean Oil 8001227 50.00 50.00 50.00 Coconut Oil 8001318 23.60 23.6023.60 Light Mineral Oil 8012951 2.14-2.48^(b) 3.97-4.14^(b) 5.80Cyclomethicone 69430246 5.00 5.00 5.00 Cetostearyl Alcohol 67762270 3.503.50 3.50 Stearic Acid 57114 3.00 3.00 3.00 Myristyl Alcohol 112721 2.502.50 2.50 Hydrogenated Castor Oil 8001783 2.00 2.00 2.00 White Wax(Beeswax) 8012893 2.00 2.00 2.00 Stearyl Alcohol 112925 1.50 1.50 1.50Docosanol (Behenyl alcohol) 661198 1.10 1.10 1.10 Total Bulk 100.00100.00 100.00 AP-70 (butane, butane 106978 12.0 12.0 12.0 isobutane andisobutane 75285 propane)^(c) propane 74986 ^(a)The amount of minocyclinehydrochloride is adjusted by the potency of the minocyclinehydrochloride. ^(b.)The amount of light mineral oil in the formulationis adjusted based on the amount of minocycline hydrochloride. Forexample, if the potency of minocycline is 100%, then the amount ofminocycline hydrochloride is 3% and amount of the mineral oil is 2.8% orthen the amount of minocycline hydrochloride is 1.5% and amount of themineral oil is 4.3%. ^(c)AP-70 (CAS # 6847-86-8) is a mixture of about27% w/w butane, 18% w/w isobutane and 55% w/w propane.

TABLE 5A Formulations of 1% Minocycline and 4% Minocycline with SiO₂Formulations 244B (FXFM244-1%) 244A(FXFM244-4%) (1% Minocycline) (4%Minocycline) Ingredients % w/w % w/w Light Mineral oil 4.44 1.11Cyclomethicone 5.00 5.00 Coconut oil 23.60 23.60 Soybean oil 50.00 50.00Hydrogenated castor oil 2.00 2.00 Beeswax 2.00 2.00 Myristyl alcohol2.50 2.50 Cetostearyl alcohol 3.50 3.50 Stearyl alcohol 1.50 1.50Behenyl alcohol 1.10 1.10 Fumed Silica (SiO₂) 0.25 0.25 Stearic acid3.00 3.00 Minocycline HCl 1.11 4.44 (micronized) (90% potency) Total 100100 Propellant AP-70 12.00 12.00

TABLE 5B Formulations of 1% Minocycline and 4% Minocycline without SiO₂(FMX-101 Foam). FMX-101 FMX-101 (1%) (4%) FOAM FOAM QuantitativeQuantitative Composition Composition Component (% w/w) (% w/w)Minocycline Hydrochloride 4.00^(a) 1.00^(a) (micronized) (expressed asminocycline) Soybean Oil 50.00 50.00 Coconut Oil 23.60 23.60 LightMineral Oil 0.91-1.37^(b) 4.58-4.69^(b) Cyclomethicone 5.00 5.00Cetostearyl Alcohol 3.50 3.50 Stearic Acid 3.00 3.00 Myristyl Alcohol2.50 2.50 Hydrogenated Castor Oil 2.00 2.00 White Wax (Beeswax) 2.002.00 Stearyl Alcohol 1.50 1.50 Docosanol(behenyl 1.10 1.10 alcohol)Total Bulk 100 100 AP-70 (butane + isobutane + 12.0 12.0 propane)^(C)^(a)The amount of minocycline hydrochloride is adjusted by the potencyof the minocycline hydrochloride. ^(b)The amount of light mineral oil inthe formulation is adjusted based on the amount of minocyclinehydrochloride. For example if the potency of minocycline is 100%, thenthe amount of minocycline hydrochloride is 4% and amount of the mineraloil is 1.8% or then the amount of minocycline hydrochloride is 1% andamount of the mineral oil is 4.8%. ^(c)AP-70 (CAS # 6847-86-8) is amixture of about 27% w/w butane, 18% w/w isobutene and 55% w/w propane.

TABLE 5C Formulation of DOX-244B with SiO₂ Ingredient Name % W/W Coconutoil 23.60 Mineral oil light 4.35 soybean oil 50.00 stearic acid 3.00behenyl alcohol 1.10 hydrogenated castor oil 2.00 Beeswax 2.00 Stearylalcohol 1.50 Cetostearyl alcohol 3.50 Myristyl alcohol 2.50Cyclomethicone 5.00 Silicon dioxide 0.25 Doxycycline Hyclate(micronized) 1.20

TABLE 5D Formulation of FDX104 and placebo without SiO₂ FDX-104 4% FOAMQuantitative FDX-104 Placebo FOAM Composition Quantitative CompositionComponent (% w/w) (% w/w) Doxycycline hyclate 4.00^(a) — (micronized)(expressed as doxycycline) Soybean Oil 50.00 50.00 Coconut Oil 23.6023.60 Light Mineral Oil 0.95-1.21^(b) 5.80 Cyclomethicone 5.00 5.00Cetostearyl Alcohol 3.50 3.50 Stearic Acid 3.00 3.00 Myristyl Alcohol2.50 2.50 Hydrogenated Castor Oil 2.00 2.00 White Wax (Beeswax) 2.002.00 Stearyl Alcohol 1.50 1.50 Docosanol 1.10 1.10 Total Bulk 100 100AP-70 (butane + 12.0 12.0 isobutane + propane)^(C) ^(a)The amount ofdoxycycline hyclate is adjusted by the potency of the doxycyclinehyclate. ^(b)The amount of light mineral oil in the formulation isadjusted based on the amount of doxycycline hyclate. For example if thepotency of doxycycline is 100%, then the amount of doxycycline hyclateis 4% and amount of the mineral oil is 1.8%. ^(C)AP-70 (CAS # 6847-86-8)is a mixture of about 27% w/w butane, 18% w/w isobutene and 55% w/wpropane.

TABLE 5E Formulations of DOX331 and DOX332 without SiO₂ FormulationsDOX331 DOX332 Ingredient % w/w % w/w Mineral oil, heavy* 82.24 88.24Mineral oil, light 5.00 — Stearyl alcohol 4.50 3.70 Stearic acid 2.502.50 Behenyl alcohol 1.10 0.70 Paraffin 51-53 — 0.20 doxycycline hyclate4.66 4.66 (micronized)** Total 100.00 100.00 AP-70 12% 12% *The amountof heavy mineral oil in the formulation is adjusted based on the mountof doxycycline hyclate. **The amount of doxycycline hyclate is adjustedby the potency of the doxycycline hyclate.

TABLE 5F Formulation of Doxycycline and adapalene without SiO₂Formulations DOD-003 Ingredient % w/w Mineral oil heavy* 81.94 Mineraloil light 5 Stearyl alcohol 4.5 Stearic acid 2.5 Behenyl alcohol 1.1Doxycycline 4.66 hyclate (micronized)** Adapalene 0.3 Total 100 AP-7012% *The amount of heavy mineral oil in the formulation is adjustedbased on the amount of doxycycline hyclate. **The amount of doxycyclinehyclate is adjusted by the potency of the doxycycline hyclate.

TABLE 5G Formulations of Minocycline and adapalene without SiO₂ MCD-MCD- MCD- MCD- MCD- Component 037 045 052 053 058 Mineral oil “heavy”*82.00 88.60 49.00 43.40 Mineral oil light* 5.00 0.70 39.00 39.00Myristyl alcohol 2.50 Cetostearyl alcohol 3.50 Stearyl alcohol 4.50 3.601.50 3.80 4.30 Stearic acid 2.50 2.40 3.00 2.40 2.50 Cyclomethicone 55.00 5.00 Coconut oil 23.60 Soybean oil 50.00 Behenyl alcohol 1.10 0.501.10 0.70 0.70 Beeswax 2.00 Hydrogenated castor oil 2.00 MCH(micronized)** 4.80 4.80 4.80 4.80 4.80 Adapalene 0.10 0.10 0.30 0.300.30 Total 100.00 100.00 100.00 100.00 100.00 AP-70 12% 12% 12% 12% 12%*The amount of heavy mineral oil or light mineral oil in the formulationis adjusted based on the amount of Minocycline hydrochloride. **Theamount of minocycline hydrochloride is adjusted by the potency of theminocycline hydrochloride.

TABLE 5H Formulation of Minocycline with fatty alcohol without SiO₂Component MCD-065 Mineral oil light* 45.55 Stearyl alcohol 4.00 Soybeanoil 45.05 Behenyl alcohol 0.60 MCH (micronized)** 4.80 Total 100.00AP-70 12% Foam quality G *The amount of light mineral oil in theformulation is adjusted based on the amount of Minocyclinehydrochloride. **The amount of minocycline hydrochloride is adjusted bythe potency of the minocycline hydrochloride.

All inactive ingredients used in the formulation are intended fortopical use and listed in the current FDA Inactive Ingredient Database;concentrations used do not exceed the maximum concentrations given inDatabase.

Example 4 Chemical and Physical Stability

The achievement of a long term stable foamable formulation oftetracycline antibiotics described herein, was a major challenge andrequired both extensive research and creativity.

The chemical and physical stability results of minocycline HCl (MCH) anddoxycycline hyclate (“DOX”) in SiO₂-containing oleaginous formulations,MCH244 and DOX244, respectively, are described in U.S. application Ser.No. 14/147,376 (U.S. Pub. No. 2014/0121188) and incorporated byreference herein. In an accelerated stability study, samples were storedat 40° C., and the concentrations of minocycline HCl and doxycyclinehyclate were determined by UPLC. Stability test for MCH244 resultsfollowing 2 months, 3 months, 6 months, 9 months, 12 months, 18 months,and 24 months of storage are shown herein below.

The following examples illustrate the chemical stability of minocyclineHCl (“MCH”) and doxycycline hyclate (“DOX”) in oleaginous formulations,as described in Tables 6, 7, and 9-11 below. In an accelerated stabilitystudy, samples were stored at 40° C., and the concentrations ofminocycline HCl and doxycycline hyclate were determined by UPLC. Thestability test results following 2 months, 3 months, 6 months, 9 months,12 months, and 18 months of storage are shown herein below.

Samples of MCH244 and DOX244 1% and 4% were stored at 25° C. and 40° C.in order to test physical and chemical stability.

Inspection of Formulation in Glass Bottles

The use of pressurized glass bottles enables the inspection offormulations for homogeneity in the presence of propellant. Following 18months of storage at 25° C. the formulation was found to bere-dispersible, i.e., homogeneous following slight shaking.

Stability Following Storage at 25° C. and 40° C.

Storage at 25° C. and 40° C. for 18 months revealed almost no change inthe Minocycline concentration. Test results for chemical stability ofminocycline following storage for up to 18 months at 25° C. and 40° C.are summarized in Table 6 and Table 7. There was practically nodegradation of 244 1% and 4% minocycline following 18 months at 25° C.and also following 9 months at 40° C. These stability results indicateshelf life of more than two years at ambient temperature. Test resultsfor chemical stability of doxycycline following storage for up to 9months at 25° C. and 40° C. are summarized in Tables 9-11. There waspractically no degradation of doxycycline following 6 months at 25° C.and at 40° C. These stability results likewise indicate a long shelflife of more than two years at ambient temperature. In one or moreembodiments, the tetracycline composition has a shelf life of at least 6months, or at least 9 months, or at least 12 months, or at least 15months, or at least 18 months, or at least 21 months, or at least 24months at ambient temperature. In one or more embodiments, thetetracycline composition has a shelf life of at least 6 months, or atleast 9 months, or at least 12 months, or at least 15 months, or atleast 18 months, or at least 21 months, or at least 24 months at 25° C.In one or more embodiments, the tetracycline composition has a shelflife of at least 1 month, or at least 3 months, or at least 6 months, orat least 9 months, or at least 12 months at 40° C.

TABLE 6 Minocycline content in MC11244 1% (with SiO₂) following storagefor 18 months at 25° C. and 40° C. Minocycline content (% w/w) Temp T =0 3M 6M 9M 12M 18M 25° C. 1.001 NM 0.986 1.007 0.972 0.959 40° C. 1.0011.002 0.983 0.965 NM NM NM = not measured

TABLE 7 Minocycline content in MC11244 4% following storage for 18months at 25° C. and 40° C. (Lot MCH-244-100825) (with SiO₂) Minocyclinecontent (% w/w) Temp T = 0 1M 3M 6M 9M 12M 18M 25° C. 4.049 NM NM 3.9933.991  3.886 3.701 40° C. 4.049 3.935 3.852 4.035 3.9137 NM NM

Minocycline Physical Stability:

The results for physical stability following storage at 25° C. and 40°C. for 18 months were as follows:

Foam quality: Conformed to the foam quality specification followingstorage for 9 months at 40° C.

Odor: Conformed to the specifications and showed no odor followingstorage at 40° C. for 9 months.

Color: The color of the formulation remained light, slightly changed togrey-yellow following storage at 40° C. for 9 months. No change wasobserved at 25° C.

Shakeability: Conformed to specifications following storage at 40° C.for 9 months.

Density: No significant change in density was found after storage at 40°C. for 9 months.

Collapse time: No change in foam collapse time (the time for the foam toreach half of its initial height) was found in any of the formulationsamples tested after storage for 9 months at 40° C.

Microscopic observations: No significant change in the microscopicappearance was noted following storage at 40° C. for 9 months.

Corrosion and deterioration: The coated aluminum surfaces of the can andvalve and the plastic housing of the valve appeared fully intact andshowed no signs of corrosion or deterioration. No changes in color ordeformation were observed.

Doxycycline DOX-244B Physical and Chemical Stability:

The results for physical stability following storage at 25° C. for 18months and for 24 months were as follows:

Foam quality: excellent.

Collapse time: At least 180 seconds.

Production: GMP Compliance.

For the purpose of clinical supplies, the production of the compositionswas performed according to the principles of current good manufacturingpractice (c-GMP). Production conditions were aimed to ensure highquality of the product and to prevent any potential cross contamination.The production site was certified by the Israel Ministry of Health assuitable for GMP production and supply of small clinical batches forPhase I and Ha clinical trials.

The below composition was prepared according to the manufacturingprocedures detailed in Example 1.

TABLE 8 Formulation of DOX-244B-111123 Ingredient Name % W/W Coconut oil23.60 Mineral oil light 4.35 soybean oil 50.00 stearic acid 3.00 behenylalcohol 1.10 hydrogenated castor oil 2.00 Beeswax 2.00 Stearyl alcohol1.50 Cetostearyl alcohol 3.50 Myristyl alcohol 2.50 Cyclomethicone 5.00Silicon dioxide 0.25 Doxycycline Hyclate (micronized) 1.20

TABLE 9 Doxycycline content (%) in DOX-244B-111123 PF following storagefor 9 months at 5° C., 25° C., 40° C., and 50° C. Doxycycline content (%w/w) T = 0 1M 2M 3M Batch/Sample 5° C. 25° C. 50° C. 25° C. 50° C. 25°C. 40° C. name DOX-244- 1.0220 1.031 1.022 — — — 1.010 1.031 111123 PFDOX-244- 1.0800 1.098 1.080 1.060 — 1.045 1.082 1.046 111123 PFFDoxycycline content (% w/w) 6M 9M 12M 18M 24M Batch/Sample 25° C. 40° C.25° C. 25° C. 25° C. 25° C. name DOX-244- 1.017 1.025 1.053 0.967 0.9941.021 111123 PF DOX-244- 1.046 1.028 1.091 1.044 1.018 1.051 111123 PFF

TABLE 10 Stability of Doxycycline Foam at 25° C. and 40° C. %¹Doxycycline Hyclate in DOX244 foam product Months 40° C. (foam) 25° C.(foam) 0 102.2 102.2 1 102.2 2 3 103.1 101.0 6 102.5 101.7 9 105.3 1296.7 18 99.4 24 102.1 ¹The percentages are derived from the PF figuresin Table 9. Note 1.2% doxycycline hyclate is equivalent to 1.0176%.doxycycline based on USP

TABLE 11 Degradation of Doxycycline at 5° C., 25° C., 40° C., and 50° C.Degradation Batch/Sample DOX-244B- DOX-244B- product w/w name 111123 PF111123 PFF T0 RRT 0.75 0.003 0.004 RRT 0.85 0.010 0.011 1M  5° C. 0.0030.003 RRT 0.75  5° C. 0.010 0.010 RRT 0.85 25° C. 0.003 0.003 RRT 0.7525° C. 0.010 0.010 RRT 0.85 50° C. — 0.003 RRT 0.75 50° C. — 0.01 RRT0.85 2M 50° C. — 0.003 RRT 0.75 50° C. — 0.009 RRT 0.85 3M 25° C. 0.0030.004 RRT 0.75 25° C. 0.01 0.011 RRT 0.85 40° C. 0.003 0.003 RRT 0.7540° C. 0.01 0.01 RRT 0.85 6M 25° C. 0.003 0.003 RRT 0.75 25° C. 0.010.01 RRT 0.85 40° C. 0.003 0.003 RRT 0.75 40° C. 0.01 0.01 RRT 0.85 9M25° C. 0.003 0.003 RRT 0.75 25° C. 0.009 0.01 RRT 0.85 12M  25° C. 0.0030.003 RRT 0.75 25° C. 0.009 0.009 RRT 0.85 18M  25° C. 0.003 0.003 RRT0.75 25° C. 0.009 0.009 RRT 0.85 24M  25° C. 0.003 0.003 RRT 0.75 25° C.0.009 0.009 RRT 0.85

TABLE 12 Appearance and Collapse time of Doxycycline at 25° C. and 40°C. Appear- Appear- Collapse Collapse ance ance time (25° C.) time (40°C.) Time (25° C.) (40° C.) Collapse Time to Collapse Time to PointsQuality Quality time(sec) FG(sec) time(sec) FG(sec)  T0 G — 100 150 — — 3M E G 115 90  165   90  6M E G >180  120 >180 >180  9M E — 150 120 — —12M G — 105 120 — — 18M E — >180  >180  — — 24M E — >180  >180  — —

Doxycycline DOX-330A-140331 (without SiO₂) physical and chemicalstability:

The results for physical stability following storage at 25° C. for 9months and for 12 months were as follows:

Foam quality: Excellent.

Collapse time: At least 180 seconds.

Production: GMP Compliance.

For the purpose of clinical supplies, the production of the compositionswas performed according to the principles of current good manufacturingpractice (c-GMP). Production conditions were aimed to ensure highquality of the product and to prevent any potential cross contamination.The production site was certified by the Israel Ministry of Health assuitable for GMP production and supply of small clinical batches forPhase I and IIa clinical trials.

The below composition was prepared according to the manufacturingprocedures detailed in Example 1.

TABLE 13 Formulation of DOX-330A-140331 (FDX104 without SiO₂) IngredientName % W/W Coconut oil 23.60 Mineral oil light 0.90 soybean oil 50.00stearic acid 3.00 behenyl alcohol 1.10 hydrogenated castor oil 2.00Beeswax 2.00 Stearyl alcohol 1.50 Cetostearyl alcohol 3.50 Myristylalcohol 2.50 Cyclomethicone 5.00 Doxycycline Hyclate (micronized) 4.90

TABLE 14 Doxycycline % content in DOX-330A-140331 PF following storagefor 12 months at 25° C. and 40° C. T = 0 3w 2M 3M 6M 9M 12M Batch/Sample40° C. 40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 25° C. name DOX-330A-4.032 3.984 3.981 4.086 3.942 4.086 4.088 3.993 4.032 140331 PF

TABLE 15 Stability of Doxycycline Foam Formulation without SiO₂ at 25°C. and 40° C. %² Doxycycline Hyclate in DOX330 foam product Months 40°C. (foam) 25° C. (foam) 0 100.8 100.8 0.75 99.6 2 99.5 3 98.6 102.2 6102.2 102.2 9 99.8 12 100.8 18 24 ²The percentages are derived from thePF figures in Table 14. Note 1.2% doxycycline hyclate is equivalent to1.0176%. doxycycline based on USP

TABLE 16 Degradation of Doxycycline in Formulation without SiO₂ at 25°C. and 40° C. Degradation Batch/Sample DOX-330A- product w/w name 140331PF T0 RRT 0.85 — 3w  40° C. 0.017 RRT 0.85 2M 40° C. 0.014 RRT 0.85 3M25° C. 0.016 RRT 0.85 40° C. 0.016 RRT 0.85 6M 25° C. 0.017 RRT 0.85 40°C. 0.017 RRT 0.85 9M 25° C. 0.020 6-epi (RRT 0.85) 12M  25° C. 0.02136-epi (RRT 0.85)

TABLE 17 Appearance and Collapse time of Doxycycline Foam Formulationwithout SiO₂ at 25° C. and 40° C. Appear- Appear- Collapse time Collapsetime ance ance (25° C.) (40° C.) Time (25° C.) (40° C.) Collapse Time toCollapse Time to Points Quality Quality time(sec) FG(sec) time(sec)FG(sec) T0 E —  160 >180 — — 3W — E− falls a — — >180 >180 little 2M — E— — >180 >180 3M E E >180 >180  180 >180 6M E E >180 >180 >180 >180 9M E— >180 >180 — — 12M  E — >180 >180 — —

Doxycycline physical and chemical stability in formulation without SiO₂:

The results for physical stability following storage at 25° C. for 9months and for 6 months were as follows:

Foam quality: Excellent.

Odor: No odor

Collapse time: At least 120 seconds.

Production: GMP Compliance.

For the purpose of clinical supplies, the production of the compositionswas performed according to the principles of current good manufacturingpractice (c-GMP). Production conditions were aimed to ensure highquality of the product and to prevent any potential cross contamination.The production site was certified by the Israel Ministry of Health assuitable for GMP production and supply of small clinical batches forPhase I and IIa clinical trials.

The below composition was prepared according to the manufacturingprocedures detailed in Example 1.

TABLE 18 Formulation of DOX-330A-140818 PF (FDX104) Ingredient Name %W/W Coconut oil 23.60 Mineral oil light 1.13 soybean oil 50.00 stearicacid 3.00 behenyl alcohol 1.10 hydrogenated castor oil 2.00 Beeswax 2.00Stearyl alcohol 1.50 Cetostearyl alcohol 3.50 Myristyl alcohol 2.50Cyclomethicone 5.00 Doxycycline Hyclate (micronized) 4.67

TABLE 19 Doxycycline % content in DOX-330A-140818 (FDX104) PF withoutSiO₂ following storage for 9 months at 25° C. and 40° C. Doxycyclinecontent (% w/w) T = 0 1M 3M 6M 9M 12M 18M 24M Batch/Sample 40° C. 25° C.40° C. 25° C. 40° C. 25° C. 25° C. 25° C 25° C. name DOX-330A- 3.9083.899 3.792 3.763 3.727 3.783 3.763 140818 PF

TABLE 20 Stability of Doxycycline Foam at 25° C. and 40° C. %³Doxycycline in DOX330 140818 Months 40° C. (foam) 25° C. (foam) 0 97.797.7 1 97.5 3 94.1 94.8 6 94.6 93.2 9 94.1 12 18 24 ³The percentages arederived from the PF figures in Table 19. Note 1.2% doxycycline hyclateis equivalent to 1.0176%. doxycycline based on USP

TABLE 21 Degradation of Doxycycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name DOX330 140818 T = 0 RRT 0.85 0.016 (6-epi)1M 40° C. 0.017 RRT 0.85 (6-epi) 3M 25° C. 0.019 6-epi 40° C. 0.0196-epi 6M 25° C. 0.019 6-epi 40° C. 0.019 6-epi 9M 25° C. 0.019 6-epi

TABLE 22 Appearance and Collapse time of Doxycycline at 25° C. and 40°C. Appear- Appear- Collapse time Collapse time ance ance (25° C.) (40°C.) Time (25° C.) (40° C.) Collapse Time to Collapse Time to PointsQuality Quality time(sec) FG(sec) time(sec) FG(sec) T0 E — 155  180 1M E— 90 >180 3M E E 180 >180 150 >180 6M E E 180 >180 >180  >180 9M E — 120>180

Doxycycline and Adapalene DOD-003 Physical and Chemical Stability:

TABLE 23 Doxycycline % content in DOD-003 following storage for 1 monthat 25° C., 40° C. and 60° C. Doxycycline content (% w/w) Batch/Sample T= 0 1M name 25° C./40° C. 60° C. 25° C. 40° C. 60° C. DOD-003 3.8503.880 3.949 3.860 3.824

TABLE 24 Stability of Doxycycline at 25° C., 40° C. and 60° C. %⁴Doxycycline in DOD-003 Months 25° C. (foam) 40° C. (foam) 60° C. (Prefoam formulation) 0 96.3 96.3 97.0 1 98.7 96.5 95.6 ⁴The percentages arederived from the figures in Table 23.

TABLE 25 Degradation of Doxycycline at 25° C., 40° C. and 60° C.Degradation product w/w Batch/Sample name DOD-003 T = 0 25° C. 6-epi0.021 40° C. 6-epi 0.021 60° C. 6-epi 0.022 1M 25° C. 6-epi 0.022 40° C.6-epi 0.021 60° C. 6-epi 0.021

TABLE 26 Appearance, Collapse time and shakeability of Doxycycline at25° C. and 40° C. in DOD-003 Time Appearance Collapse time Pts 25° C.40° C. 60° C. 25° C. 40° C. 60° C. Collapse Time to Collapse Time toCollapse Time to Quality Quality Quality time (s) FG (s) time (s) FG (s)time (s) FG (s) T0 E E NM >180 >180 >180 >180 NM NM 1M E E NM >180 120 >180  120 NM NM Time Points Shakeability (25° C.) Shakeability (40°C.) Shakeability (60° C.) T0 2 2 NM 1M 0 2 NM ⁴The percentages arederived from the figures in Table 23.

TABLE 27 Adapalene % content in DOD-003 following storage for 1 month at25° C., 40° C. and 60° C. Adapalene content (% w/w) Batch/Sample T = 01M name 25° C./40° C. 60° C. 25° C. 40° C. 60° C. DOD-003 0.2948 0.29480.3030 0.2950 0.3076

TABLE 28 Stability of Adapalene at 25° C., 40° C. and 60° C. %⁵Adapalene in DOD-003 25° C. 40° C. 60° C. (Pre foam Months (foam) (foam)formulation) 0 98.3 98.3 98.3 1 101.0 98.3 102.5 ⁵The percentages arederived from the FIGURES in Table 27.

Minocycline and Adapalene MCD-037-160320 Physical and ChemicalStability:

TABLE 29 Minocycline % content in MCD-037-160320 following storage for 4months at 25° C. and 40° C. Minocycline content (% w/w) Batch/Sample T =0 1M 2M 3M 4M name 25° C./40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 40°C. 25° C. 40° C. MCD-037- 3.89 NM 3.90 NM 4.03 3.88 3.89 3.99 3.95160320

TABLE 30 Stability of Minocycline at 25° C. and 40° C. %⁶ Minocycline inMCD-037-160320 Months 25° C. (foam) 40° C. (foam) 0 97.22 97.22 1 NM97.62 2 NM 100.68 3 97.01 97.30 4 99.66 98.79 ⁶The percentages arederived from the figures in Table 29.

TABLE 31 Degradation of Minocycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name MCD-037-160320 T = 0 25° C. 4-epi 0.06 40°C. 4-epi 0.06 1M 25° C. 4-epi NM 40° C. 4-epi 0.10 2M 25° C. 4-epi NM40° C. 4-epi 0.08 3M 25° C. 4-epi 0.07 40° C. 4-epi 0.09 4M 25° C. 4-epi0.09 40° C. 4-epi 0.10

TABLE 32 Appearance, collapse time, shakeability and homogeneity ofMinocycline at 25° C. and 40° C. in MCD-037-160320 Appearance AppearanceCollapse time (25° C.) Collapse time (40° C.) Time (25° C.) (40° C.)Collapse Time to Collapse Time to Points Quality Quality time(sec)FG(sec) time(sec) FG(sec) T0 E E >180 >180 >180 >180 1M NM E NMNM >180 >180 2M NM E NM NM >180 >180 3M E E >180 >180 >180 >180 4M EE >180 >180 >180 >180 Time Shakeability Shakeability Points (25° C.)(40° C.) Homogeneity (25° C.) Homogeneity (40° C.) T0 2 2 Crystalsuniformly Crystals uniformly distributed distributed 1M NM 2 NM Crystalsuniformly distributed 2M NM 2 NM Crystals uniformly distributed 3M 2 2Crystals uniformly Crystals uniformly distributed distributed 4M 2 2Crystals uniformly Crystals uniformly distributed distributed

TABLE 33 Adapalene % content in MCD-037-160320 following storage for 4months at 25° C. and 40° C. Adapalene content (% w/w) T = 0 1M 2M 3M 4MBatch/Sample 25° C./40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. 25°C. 40° C. name MCD-037- 0.09 NM 0.10 NM 0.10 0.10 0.10 0.0967 0.10160320

TABLE 34 Stability of Adapalene at 25° C. and 40° C. %⁷ Adapalene inMCD-037-160320 Months 25° C. (foam) 40° C. (foam) 0 93.9 93.9 1 NM 96.92 NM 95.7 3 96.4 97.4 4 96.7 97.10 ⁷The percentages are derived from thefigures in Table 33.

Minocycline and Adapalene MCD-045-160306 Physical and ChemicalStability:

TABLE 35 Minocycline % content in MCD-045-160306 following storage for 3months at 25° C. and 40° C. Minocycline content (% w/w) T = 0 1M 2M 3MBatch/Sample 25° C./40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 40° C.name MCD-045- 3.83 NM 4.21 NM 3.93 3.91 3.96 160306

TABLE 36 Stability of Minocycline at 25° C. and 40° C. %⁸ Minocycline inMCD-045-160306 Months 25° C. (foam) 40° C. (foam) 0 95.76 95.76 1 NM105.15 2 NM 98.14 3 97.79 99.08 ⁸The percentages are derived from thefigures in Table 35.

TABLE 37 Degradation of Minocycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name MCD-045-160306 T = 0 25° C. 4-epi 0.07 40°C. 4-epi 0.07 1M 25° C. 4-epi NM 40° C. 4-epi 0.11 2M 25° C. 4-epi NM40° C. 4-epi 0.07 3M 25° C. 4-epi 0.08 40° C. 4-epi 0.10

TABLE 38 Appearance, collapse time, shakeability and homogeneity ofMinocycline at 25° C. and 40° C. in MCD-045-160306 Appearance AppearanceCollapse time (25° C.) Collapse time (40° C.) Time (25° C.) (40° C.)Collapse Time to Collapse Time to Points Quality Quality time(sec)FG(sec) time(sec) FG(sec) T0 E E >180 >180 >180 >180 1M NM E NMNM >180 >180 2M NM E NM NM >180 >180 3M E E >180 >180 >180  150 4M EE >180 >180  140  120 Time Shakeability Shakeability Points (25° C.)(40° C.) Homogeneity (25° C.) Homogeneity (40° C.) T0 2 2 Crystalsuniformly Crystals uniformly distributed distributed 1M NM 2 NM Crystalsuniformly distributed 2M NM 2 NM Crystals uniformly distributed 3M 2 2Crystals uniformly Crystals uniformly distributed distributed 4M 2 2Crystals uniformly Crystals uniformly distributed distributed

TABLE 39 Adapalene % content in MCD-045-160306 following storage for 3months at 25° C. and 40° C. Adapalene content (% w/w) T = 0 1M 2M 3MBatch/Sample 25° C./40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 40° C.name MCD-045- 0.10 NM 0.10 NM 0.10 0.09 0.10 160306

TABLE 40 Stability of Adapalene at 25° C. and 40° C. %⁹ Adapalene inMCD-045-160306 Months 25° C. (foam) 40° C. (foam) 0 95.10 95.03 1 NM101.13 2 NM 95.80 3 94.40 95.83 ⁹The percentages are derived from thefigures in Table 39.

Minocycline and Adapalene MCD-052-160410 Physical and ChemicalStability:

TABLE 41 Minocycline % content in MCD-052-160410 following storage for 3months at 25° C. and 40° C. Minocycline content (% w/w) T = 0 1M 2M 3MBatch/Sample 25° C./40° C. 25° C. 40° C. 25° C. 40° C. 25° C. 40° C.name MCD-052- 3.94 3.88 3.71 3.82 3.80 3.81 3.84 160410

TABLE 42 Stability of Minocycline at 25° C. and 40° C. %¹⁰ Minocyclinein MCD-052-160410 Months 25° C. (foam) 40° C. (foam) 0 98.48 98.48 197.02 92.75 2 95.43 95.08 3 95.30 96.05 ¹⁰The percentages are derivedfrom the FIGURES in Table 41.

TABLE 43 Degradation of Minocycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name MCD-052-160410 T = 0 25° C. 4-epi 0.09 40°C. 4-epi 0.09 1M 25° C. 4-epi 0.07 40° C. 4-epi 0.06 2M 25° C. 4-epi0.08 40° C. 4-epi 0.08 3M 25° C. 4-epi 0.09 40° C. 4-epi 0.07

TABLE 44 Appearance, collapse time, shakeability and homogeneity ofMinocycline at 25° C. and 40° C. in MCD-052-160410 Appear- Appear-Collapse time Collapse time ance ance (25° C.) (40° C.) Time (25° C.)(40° C.) Collapse Time to Collapse Time to Points Quality Qualitytime(sec) FG(sec) time(sec) FG(sec) T0 E E >180 >180 >180 >180 1M EE >180 >180 >180 >180 2M E E >180 >180 >180 >180 3M E E NM NM NM NMShake- Shake- Time ability ability Homogeneity Homogeneity Points (25°C.) (40° C.) (25° C.) (40° C.) T0 2 2 Crystals uniformly Crystalsuniformly distributed distributed 1M 2 2 Crystals uniformly Crystalsuniformly distributed distributed 2M 2 2 Crystals uniformly Crystalsuniformly distributed distributed 3M 0 0 Crystals uniformly Crystalsuniformly distributed distributed

TABLE 45 Adapalene % content in MCD-052-160410 following storage for 3months at 25° C. and 40° C. Adapalene content (% w/w) T = 0 1M 2M 3MBatch/ 25° C./ 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. Sample 40° C.name MCD- 0.29 0.29 0.29 0.30 0.30 0.30 0.29 052- 160410

TABLE 46 Stability of Adapalene at 25° C. and 40° C. %¹¹ Adapalene inMCD-052-160410 Months 25° C. (foam) 40° C. (foam) 0 97.31 97.31 1 95.5096.74 2 98.69 99.00 3 99.16 97.78

Minocycline and Adapalene MCD-053-160413 Physical and ChemicalStability:

TABLE 47 Minocycline % content in MCD-053-160413 following storage for 3months at 25° C. and 40° C. Minocycline content (% w/w) T = 0 1M 2M 3MBatch/ 25° C./ 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. Sample 40° C.name MCD- 3.91 3.95 3.91 3.84 3.88 3.97 3.94 053- 160413 ¹¹Thepercentages are derived from the FIGURES in Table 45.

TABLE 48 Stability of Minocycline at 25° C. and 40° C. %¹² Minocyclinein MCD-053-160413 Months 25° C. (foam) 40° C. (foam) 0 97.79 97.79 198.64 97.69 2 96.03 96.98 3 99.32 98.43

TABLE 49 Degradation of Minocycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name MCD-053-160413 T = 0 25° C. 4-epi 0.07 40°C. 4-epi 0.07 1M 25° C. 4-epi 0.07 40° C. 4-epi 0.08 2M 25° C. 4-epi0.08 40° C. 4-epi 0.09 3M 25° C. 4-epi 0.11 40° C. 4-epi 0.11 ¹²Thepercentages are derived from the FIGURES in Table 47.

TABLE 50 Appearance, collapse time, shakeability and homogeneity ofMinocycline at 25° C. and 40° C. in MCD-053-160413 Collapse Collapsetime (25° C.) time (40° C.) Appearance Appearance Collapse Time CollapseTime Time (25° C.) (40° C.) time to FG time to FG Points Quality Quality(sec) (sec) (sec) (sec) T0 E E >180 >180 >180 >180 1M E E >18060 >180 >180 2M E E 175 180 180 180 Time Shakeability ShakeabilityHomogeneity Homogeneity Points (25° C.) (40° C.) (25° C.) (40° C.) T0 22 Crystals Crystals uniformly uniformly distributed distributed 1M 2 2Crystals Crystals uniformly uniformly distributed distributed 2M 2 2Crystals Crystals uniformly uniformly distributed distributed

TABLE 51 Adapalene % content in MCD-053-160413 following storage for 3months at 25° C. and 40° C. Adapalene content (% w/w) T = 0 1M 2M 3MBatch/ 25° C./ 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. Sample 40° C.name MCD- 0.28 0.28 0.28 0.28 0.28 0.29 0.28 053- 160413

TABLE 52 Stability of Adapalene at 25° C. and 40° C. %¹³ Adapalene inMCD-053-160413 Months 25° C. (foam) 40° C. (foam) 0 93.41 93.41 1 94.6693.42 2 91.80 93.78 3 95.44 94.07 ¹³The percentages are derived from theFIGURES in Table 51.

Minocycline and Adapalene MCD-058-160414 Physical and ChemicalStability:

TABLE 53 Minocycline % content in MCD-058-160414 following storage for 3months at 25° C. and 40° C. Minocycline content (% w/w) T = 0 1M 2M 3MBatch/ 25° C./ 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. Sample 40° C.name MCD- 4.06 3.90 3.97 3.92 4.01 3.91 3.90 058- 160414

TABLE 54 Stability of Minocycline at 25° C. and 40° C. %¹⁴ Minocyclinein MCD-058-160414 Months 25° C. (foam) 40° C. (foam) 0 101.61 101.61 197.58 99.20 2 97.88 100.36 3 97.76 97.50 ¹⁴The percentages are derivedfrom the FIGURES in Table 53.

TABLE 55 Degradation of Minocycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name MCD-058-160414 T = 0 25° C. 4-epi 0.09 40°C. 4-epi 0.09 1M 25° C. 4-epi 0.09 40° C. 4-epi 0.10 2M 25° C. 4-epi0.09 40° C. 4-epi 0.10 3M 25° C. 4-epi 0.12 40° C. 4-epi 0.12

TABLE 56 Appearance, Collapse time, shakeability and homogeneity ofMinocycline at 25° C. and 40° C. in MCD-058-160414 Appearance AppearanceCollapse time (25° C.) Collapse time (40° C.) Time (25° C.) (40° C.)Collapse Time to Collapse Time to Points Quality Quality time(sec)FG(sec) time(sec) FG(sec) T0 E E >180 150 >180 150 1M EE >180 >180 >180 >180 2M E E >180 180 >180 180 Time ShakeabilityShakeability Points (25° C.) (40° C.) Homogeneity (25° C.) Homogeneity(40° C.) T0 2 2 Crystals uniformly Crystals uniformly distributeddistributed 1M 2 2 Crystals uniformly Crystals uniformly distributeddistributed 2M 2 2 Crystals uniformly Crystals uniformly distributeddistributed

TABLE 57 Adapalene % content in MCD-058-160414 following storage for 3months at 25° C. and 40° C. Adapalene content (% w/w) T = 0 1M 2M 3MBatch/ 25° C./ 25° C. 40° C. 25° C. 40° C. 25° C. 40° C. Sample 40° C.name MCD- 0.29 0.27 0.28 0.28 0.29 0.29 0.29 058- 160414

TABLE 58 Stability of Adapalene at 25° C. and 40° C. %¹⁵ Adapalene inMCD-058-160414 Months 25° C. (foam) 40° C. (foam) 0 95.01 95.01 1 91.4794.05 2 93.64 95.11 3 95.87 95.09 ¹⁵The percentages are derived from theFIGURES in Table 57.

Doxycycline DOX331 Physical and Chemical Stability:

TABLE 59 Doxycycline % content in DOX331 following storage for 1 week at25° C. and 40° C. Doxycycline content (% w/w) Batch/Sample T = 0 1 Weekname 25° C. 40° C. 25° C. 40° C. DOX331 4.146 4.146 4.103 4.106

TABLE 60 Stability of Doxycycline at 25° C. and 40° C. %¹⁶ Doxycyclinein DOX331 Time 25° C. 40° C. 0 103.7 103.7 1 week 102.6 102.7 ¹⁶Thepercentages are derived from the FIGURES in Table 59.

TABLE 61 Degradation of Doxycycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name DOX331 T = 0 25° C. 6-epi 0.026 40° C.6-epi 0.026 1 Week 25° C. 6-epi 0.026 40° C. 6-epi 0.025

TABLE 62 Appearance, collapse time and shakeability of Doxycycline at25° C. and 40° C. in DOX331 Appearance Appearance (25° C.) (40° C.)Shakeability Shakeability Time Points Quality Quality (25° C.) (40° C.)T0 E E 0 0 1 week E E 1 1

Doxycycline DOX332 Physical and Chemical Stability:

TABLE 63 Doxycycline % content in DOX332 following storage for 1 week at25° C. and 40° C. Doxycycline content (% w/w) Batch/Sample T = 0 1 Weekname 25° C. 40° C. 25° C. 40° C. DOX332 4.074 4.074 4.124 4.169

TABLE 64 Stability of Doxycycline at 25° C. and 40° C. %¹⁷ Doxycyclinein DOX332 Time 25° C. 40° C. 0 101.8 101.8 1 week 103.1 104.2

TABLE 65 Degradation of Doxycycline at 25° C. and 40° C. Degradationproduct w/w Batch/Sample name DOX332 T = 0 25° C. 6-epi 0.026 40° C.6-epi 0.026 1 Week 25° C. 6-epi 0.026 40° C. 6-epi 0.026

TABLE 66 Appearance, collapse time and shakeability of Doxycycline at25° C. and 40° C. in DOX332 Appearance Appearance (25° C.) (40° C.)Shakeability Shakeability Time Points Quality Quality (25° C.) (40° C.)T0 E E 1 1 1 week E E 1 1 ¹⁷The percentages are derived from the figuresin Table 63.

Minocycline FMX103 (1.5% Minocycline) Chemical Stability:

TABLE 67 Stability of Minocycline at 25° C., 30 ° C. and 40° C. %Minocycline in FMX103 (1.5% % Minocycline in FMX103 (1.5% minocycline)Batch: 5042301 minocycline) Batch: 5082401 Months 25° C. 30° C. 40° C.Months 25° C. 30° C. 40° C. 0 92.8- 92.8- 92.8- 0 97.8 97.8 97.8 94.694.6 94.6 1 NM 94.8 80.2 1 NM 95.9 95.4 2 NM 91.9 88.2 2 NM 94.8 92.9 392.8 91.0 87.2/ 3 96.8 96.0 92.8 87.3 6 92.4 92.0 85.9/ 6 95.9 91.2 95.985.7 9 92.4 90.5 NM 9 NM NM NM 12  NM NM NM 12  NM NM NM

TABLE 68 Degradation of Minocycline at 25° C., 30° C. and 40° C. FMX103FMX103 (1.5% (1.5% minocycline) minocycline) Degradation Batch: Batch:product w/w Batch/Sample name 5042301 5082401 T = 0 25° C. 4-epi 0.05550.0465 30° C. 4-epi 0.0555 0.0465 40° C. 4-epi 0.0555 0.0465 1M 25° C.4-epi NM NM 30° C. 4-epi 0.06 0.042 40° C. 4-epi 0.0495 0.048 2M 25° C.4-epi NM NM 30° C. 4-epi 0.0585 0.0585 40° C. 4-epi 0.057 0.063 3M 25°C. 4-epi 0.06 0.06 30° C. 4-epi 0.0555 0.057 40° C. 4-epi 0.054 0.051 6M25° C. 4-epi 0.069 0.0525 30° C. 4-epi 0.0615 0.0675 40° C. 4-epi 0.02850.0255 9M 25° C. 4-epi 0.0555 NM 30° C. 4-epi 0.0645 NM 40° C. 4-epi NMNM 12M  25° C. 4-epi NM NM 30° C. 4-epi NM NM 40° C. 4-epi NM NM

Minocycline FMX103 (3% Minocycline) Chemical Stability:

TABLE 69 Stability of Minocycline at 25° C. and 30° C. % Minocycline inFMX103 (3% % Minocycline in FMX103 (3% minocycline) Batch: 5020901minocycline) Batch: 5082601 Months 25° C. 30° C. 40° C. Months 25° C.30° C. 40° C. 0 96.4 96.4 96.4 0 98.8 98.8 98.8 1 NM 92.9 95.0 1 NM 95.696.5 2 NM NM NM 2 NM 94.5 96.6 3 94.7 93.7 92.0 3 98.2 97.9 95.5 6 93.290.6 87.5 6 97.8 97.1 93.6 9 92.0 88.7/ NM 9 NM NM NM 91.5 12 93.4 93.5NM 12 NM NM NM

TABLE 70 Degradation of Minocycline at 25° C., 30° C. and 40° C. FMX103(3% FMX103 (3% minocycline) minocycline) Degradation Batch: Batch:product w/w Batch/Sample name 5020901 5082601 T = 0 25° C. 4-epi 0.1140.09 30° C. 4-epi 0.114 0.09 40° C. 4-epi 0.114 0.09 1M 25° C. 4-epi NMNM 30° C. 4-epi 0.099 0.078 40° C. 4-epi 0.099 0.087 2M 25° C. 4-epi NMNM 30° C. 4-epi NM 0.105 40° C. 4-epi NM 0.12 3M 25° C. 4-epi 0.1140.111 30° C. 4-epi 0.111 0.102 40° C. 4-epi 0.102 0.114 6M 25° C. 4-epi0.111 0.105 30° C. 4-epi 0.099 0.105 40° C. 4-epi 0.066 0.054 9M 25° C.4-epi 0.114 NM 30° C. 4-epi 0.114 NM 40° C. 4-epi NM NM 12M  25° C.4-epi 0.102 NM 30° C. 4-epi 0.108 NM 40° C. 4-epi NM NM

Example 5 Clinical Study Phase I (FMX-101 Foam, 4% Minocycline Foamwithout SiO₂) PK Study Under Maximum Use Conditions for 16 Days

Study Synopsis

In this example, topical administration of tetracycline (for exampleminocycline) was studied and the pharmacokinetic profile of the drug andits bioavailability was characterized.

Study Title:

An Open-label, Multiple Dose Study to Assess the Pharmacokinetic Profileof Minocycline from FMX-101 Foam (4%) in Male and Female Volunteers.

Objectives:

1. To assess bioavailability of minocycline from FMX-101 minocycline HClfoam, 4%. 2. To characterize the pharmacokinetic profile of minocyclinefollowing multiple-dose topical administration of FMX-101 (4%) inhealthy volunteers with or without acne.

Study Medication:

FMX-101 minocycline (4%)—approximately 4 gr per application. Thecomposition of FMX-101 Foam (4%) is described in Table 5B above.

Dosage Form:

Foam.

Indication:

Acne vulgaris.

Design:

An open-label, single-center, non-randomized, multiple administrationsstudy in males and females, some of which are with acne. Twelve (12)subjects (at least 4 subjects with acne) enrolled to receive a dailydose of topical FMX-101 minocycline (4%) foam for sixteen consecutivedays.

Eligible subjects were admitted to the Clinical Research Center (CRC) inthe evening before the first study drug administration (Day 0), andremained in-house for 24 hours after first dosing (Day 1). Throughoutthis day blood samples for PK were drawn at time points specified below.After receiving the second dose (Day 2) they were released from the CRC.

Subjects then arrived at the CRC on the mornings of Days 3, 5, 7, 8, 9,10, 11, 12, 14 and 15. They remained under supervision in the CRC, withthe application areas uncovered, for 30 min before being released. OnDays 3, 7, 9, 11 and 14, blood was drawn for PK (trough) within 10 minbefore the subjects received the study drug.

On days 4, 6 and 13 the drug was applied at home by the subjectaccording to the Investigator/study staff instructions.

On the evening of Day 15 the subjects were re-admitted to the CRC. OnDay 16 they received the last (sixteenth) dose and went through the sameprocedures as in Day 1. After being released form the CRC they wererequired to attend three additional ambulatory PK blood sampling (36, 48and 60 hours post-dose).

PK Evaluation Timing of PK Blood Sampling

Blood samples to determine plasma of minocycline were collected at thefollowing time points:

-   -   Day 1: pre-dose (within 90 min before first dosing), 30 min, 1,        2, 4, 8, 12, 16 hours post-dose and Day 2 at 24 hrs post-dose        within 10 min before second dosing—a total of 9 samples).    -   Days 3, 7, 9, 11 and 14: pre-dose (trough) samples, within 10        min before drug application.    -   Day 16: pre-dose (within 10 min before drug application), 30        min, 1, 2, 4, 8, 12, 16 hours post-dose, Day 17, 24 (±10 min)        hours post-dose (before discharge from the CRC) and additional        ambulatory PKs at 36 (±15 min), (Day 17), 48 (±30 min) and 60        (±30 min) hours after last drug application (Day 18)—a total of        12 blood samples.

TABLE 71 PK sampling scheme Study Day Time relative to dosing Day 1 0 h(Pre-dose) 0.5 h   1 h 2 h 4 h 8 h 12 h  16 h  Day 2 Pre-dose (24 hpost-dose) Day 3 Pre-dose (24 h post-dose) Day 7 Pre-dose (24 hpost-dose) Day 9 Pre-dose (24 h post-dose) Day 11 Pre-dose (24 hpost-dose) Day 14 Pre-dose (24 h post-dose) Day 16 0 h (Pre-dose, 24 hpost-dose) 0.5 1 2 4 8 12 16 Day 17 24 36 Day 18 48 60

Throughout a period of 18 days a total of 26 samples per subject weredrawn for PK.

Calculation of Pharmacokinetic Parameters

PK of minocycline was derived from plasma concentration versus timedata. For purposes of calculating PK parameters, concentrations <LLQwere treated as zero. For purposes of tabular presentation and graphingmean profiles, concentration values <LLQ were treated as missing.

The PK parameters assessed included:

C_(max)—Maximum plasma concentration achieved (dosing days 1 and 16).

AUCT—The area under the plasma concentration versus time curve inng*mL/h. The AUC from time zero to the last experimental time point (t*)with a detectable drug concentration equal to or greater than the limitof quantification value was designated AUCT and calculated by the lineartrapezoidal rule (dosing days 1 and 16).

All calculated concentration values were electronically transferred.Individual subject PK parameter values were derived by non-compartmentalmethods by WinNonlin 6.3 within the Phoenix 64 software package. Thepeak plasma concentration (C_(max)) was obtained from experimentalobservations.

FIG. 2 depicts the mean minocycline plasma concentrations from Day 1 toDay 16 for subjects who received FMX-101.

Results:

TABLE 72 FMX101-1 PK parameters PK Non-Compartmental Analysis SummaryStatistics (Day 1, Day 16) Parameter Day 1 Day 16 C_(max) [ng/mL] 2.26 ±1.60 5.04 ± 6.19 AUC_(T) [ng · h/mL] 33.83 ± 22.73 84.36 ± 48.36

Analysis:

In general, the observed minocycline plasma concentrations throughoutthe study were low and close to the sensitive lower limit ofquantification (LLOQ=1.1 ng/mL).

The results of this study showed a very low absorption, with the C_(max)(Day 16)=5 ng/mL, about 500 times lower than the C_(max) and AUC for thelabeled dose of the oral extended release minocycline, Solodyn® (100-135mg, where the actual mg/kg dose corresponds to 1.07-0.99).

Similar PK studies for additional tetracycline antibiotics, such asdoxycycline in one or more embodiments may be undertaken. For example,PK studies for doxycycline in formulations such as FDX104, DOX331,DOX332, DOD-003, and minocycline with adapalene MCD-037, MCD-045,MCD-052 MCD-053, MCD-065 and MCD-058.

Doxycycline is generally regarded as non-toxic in short term treatment,as indicated by its oral acute toxicity of LD50=1007 mg/kg (mouse).

Chronic toxicity of doxycycline was evaluated in rats at oral doses upto 500 mg/kg/day for 18 months. Findings revealed no adverse effects ongrowth, food consumption, or survival.

Example 6 PK Study Results for Tetracycline Formulations

An open-label, single-center, study of the pharmacokinetics of dailyapplications of tetracycline formulations such as DOX331, DOX332, andDOD-003 doxycycline foam and MCD-037, MCD-045, MCD-052 MCD-053, MCD-065and MCD-058 minocycline or doxycycline foam, is conducted for 16consecutive days. Eligible subjects include males or females, 18 to 35years of age, with or without papulopustular rosacea who are otherwisehealthy. At least twelve subjects (preferably 6 male and 6 female), atleast 9 of whom have varying degrees of papulopustular rosacea and 3preferably without papulopustular rosacea, are enrolled to receive dailytopical administration of tetracycline formulation, as indicated above.Subjects are admitted to the Clinical Research Center (CRC) in theevening before the first study drug administration (Day 0), and remainin-house for 24 hours after first dosing (Day 1). Throughout this dayblood samples (6 mL) for determination of minocycline bloodconcentrations is drawn as follows:

Day 1: pre-dose (within 60 min before first dosing), 30 min, 1, 2, 4, 8,12, 16 hours post-dose and Day 2 at 24 hrs post-dose within 10 minbefore second dosing—a total of 9 samples)

After receiving the second dose (Day 2) subjects are released from theCRC. Subjects then return to the CRC on the mornings of Days 3, 5, 7, 8,9, 10, 11, 12, 14 and 15 (on Days 4, 6, and 13, subject applied thetetracycline formulation themselves). They remain in the CRC, with theapplication areas uncovered, for 30 min before being released. On Days3, 7, 9, 11 and 14, blood is drawn as follows:

Days 3, 7, 9, 11 and 14: pre-dose (trough) samples, within 10 min beforedrug application

On the evening of Day 15 the subjects are re-admitted to the CRC. On Day16 they receive the last (sixteenth) dose and undergo the sameprocedures as in Day 1 as follows:

Day 16: pre-dose (within 30 min before drug application), 30 min, 1, 2,4, 8, 12, 16 hours post-dose

After being released from the CRC they are required to attend threeadditional blood samplings at 36, 48 and 60 hours post-dose as follows:

Day 17: 24 (±10 min) hours post-dose (before discharge from the CRC) andadditional ambulatory sample at 36 (±15 min)

Day 18: 48 (±30 min) and 60 (±30 min) hours after last drug application.

Blood samples are analyzed using a validated method with a lower limitof quantification (LLQ) of 1 ng/mL. An End-of Study/Safety Follow-upvisit took place on 7-10 days after last dose, which also included adermatological assessment of response to treatment.

Results: The systemic exposure of a tetracycline foam as disclosedherein is equal to or lower than that of an orally administeredtetracycline. There are no serious adverse events (AEs) and nowithdrawals due to AEs.

Example 7 Compatibility Study

Procedure: Minocycline hydrochloride (“MCH”) was incubated as asuspension with various excipients at 25° C. and 40° C. for maximum ofsixty days or to the point where degradation was suspected. The ratiobetween MCH and the tested excipient is detailed below. Visualinspection was the major criterion for indication of compatibility. Thecolor of intact MCH suspension is pale yellow; and any change of color(e.g., to dark orange, red, green, brown and black) indicates oxidationor degradation.

Hydrophilic solvents were tested for compatibility with MCH at a ratioof MCH:excipient of 1:250. Dimethyl Isosorbide, Glycerin, Ethanol,Propylene glycol, Butylene Glycol, PEG 200, Hexylene Glycol, PEG 400,Dimethyl Sulfoxide and Diethylene glycol monoethyl ether were found tobe incompatible with MCH.

Oily emollients and waxes were tested for compatibility with MCH at aratio of MCH:excipient of 1:250 for oily emollients and 1:50 for waxes.Hydrogenated castor oil, Castor oil, Cocoglycerides, diisopropyladipate, Mineral oil light, Coconut oil, Beeswax, MCT oil,Cyclomethicone, Isododecane, Cetearyl octanoate, Gelled mineral oil,Isopropyl myristate, PPG 15 stearyl ether, Mineral oil heavy, Octyldodecanol, White Petrolatum, Petrolatum (Sofmetic), Paraffin 51-53,Paraffin 51-53, Paraffin 58-62, Calendula oil, Shea butter, Grape seedoil, Almond oil, Jojoba oil, Avocado oil, Peanut oil, Wheat germ oil andHard Fat were found to be compatible with MCH. Pomegranate seed oil wasfound to be incompatible with MCH. Other than hydrogenated castor oil,beeswax, paraffin and hard fat, the aforesaid items listed are oilyemollients.

The compatibility of MCH with hydrophobic surfactant was testedfollowing solubilization of the surfactant in mineral oil (mineral oilwas previously shown to be compatible with MCH). Surfactants were testedfor compatibility with MCH at a ratio of MCH:excipient of 1:50. PEG 150distearate, Laureth 4, PEG 40 hydrogenated castor oil, PEG 75 lanolin,Glucam P20 distearate, PEG 100 stearate, Glyceryl monostearate, PEG 40stearate, Montanov S (Cocoyl Alcohol (and) C12-20 Alkyl Glucoside),Alkyl lactate, Benton gel, SPAN 60, Sorbitan sesquistearate, SPAN 40,SPAN 80, Tween 20, Ceteth 2, Sucrose stearic acid esters D1813,Ceteareth 20, Steareth 2/Steareth 21, Methyl glucose sesquistearate,Oleth 20, PPG 20 methyl glucose ether, Tween 60 were found to beincompatible with MCH. Sucrose stearic acid esters D1803, Sucrosestearic acid esters D1807 and Sucrose stearic acid esters D1811 werefound to be compatible with MCH; however, not all of them dissolved inoil (e.g., 1811, 1813).

Foam adjuvants were tested for compatibility with MCH at a ratio ofMCH:excipient of 1:50. Isostearyl alcohol, Behenyl alcohol, Stearylalcohol, Cetyl alcohol, Oleyl alcohol, Myristyl alcohol, Cetostearylalcohol, Palmitic acid, Stearic acid and Oleic acid were found to becompatible with MCH. Isostearic acid was not compatible with MCH.

Additives were tested for compatibility with MCH at a ratio ofMCH:excipient of 1:50. Aerosil and Menthol were found to be compatiblewith MCH. Titanium dioxide and Ethocel were not compatible with MCH.

Additives were tested for compatibility with MCH. Minimal quantities ofwater (100 μL) were added to MCH, suspended in excipients that haddemonstrated compatibility to examine whether water can enhanceoxidation/degradation in the absence or presence of antioxidant. Inparallel, antioxidants were added to the MCH suspensions comprisingwater. Antioxidants were also added to excipients which were found to benon-compatible with MCH. Addition of water caused prompt degradation ofMCH. Addition of the antioxidants alpha-tocopherol, BHA/BHT and propylgallate did not prevent MCH degradation. Compatible excipients becameincompatible in the presence of water. Addition of antioxidants did notalter this result.

Doxycycline

A similar compatibility study was conducted for Doxycycline Hyclate andDoxycycline Monohydrate.

The physicochemical properties of these two forms of Doxycycline aresimilar to those of other tetracycline antibiotics with the exception ofdifferences resulting from the presence of an H₂O molecule inDoxycycline Monohydrate and an H₂O molecule and two HCl molecules forevery water molecule in Doxycycline Hyclate.

General properties of Doxycycline Hyclate and Doxycycline Monohydrate:

Doxycycline Hyclate

1. Doxycycline Hyclate is a broad-spectrum antibiotic syntheticallyderived from oxytetracycline.

2. Doxycycline hyclate is a yellow crystalline powder soluble in waterand in solutions of alkali hydroxides and carbonates.

3. Doxycycline hyclate has a high degree of lipid solubility and a lowaffinity for calcium binding.

Doxycycline Monohydrate

1. Doxycycline monohydrate is a broad-spectrum antibiotic syntheticallyderived from oxytetracycline.

2. The chemical designation of the light-yellow crystalline powder isalpha-6-deoxy-5-oxytetracycline.

The major degradative pathways for both types of Doxycycline arecarbon-4 epimerization and oxidative processes.

Doxycycline is a member of the tetracycline antibiotics group and iscommonly used to treat a variety of infections, particularly effectivein treating acne condition.

Different compositions of hydrophilic and hydrophobic solventscontaining Doxycycline Hyclate (Set I and Set II) and DoxycyclineMonohydrate (Set III) were prepared by weighing the antibiotic in aglass vial and shaking overnight with each solvent investigated.Mixtures of Doxycycline salts 1.04% w/w with solid excipients wereprepared in a similar way as for Minocycline HCl. The results arepresented in Tables 22A-26.

TABLE 73 Doxycycline Hyclate Compatibility Test (Group I) A. Mixtures of1.04% w/w of Doxycycline Hyclate stored at 25° C., 40° C. and 50° C. fortwo weeks Ingredients PPG-15 stearyl Propylene Diisopropyl Group ICyclomethicone ether Octyldodecanol Mineral oil glycol Glycerol PEG 200PEG 400 MCT oil adipate Visual White White White White Light Light LightLight White White inspection liquid and liquid and liquid and liquid andyellow yellow yellow yellow liquid and liquid and at T-0 yellow yellowyellow yellow solution solution solution solution yellow yellow powderpowder powder powder powder powder sedim. sedim. sedim. sedim. sedim.sedim. Visual White White White White Light Light Light Light WhiteWhite inspection liquid and liquid and liquid and liquid and yellowyellow yellow yellow liquid and liquid and after the yellow yellowyellow yellow solution solution solution solution yellow yellow storageat powder powder powder powder powder powder 25° C. sedim. sedim. sedim.sedim. sedim. sedim. Visual White White Light White Yellow brownishBrown Orange White White inspection liquid and liquid and orange liquidand solution Yellow solution solution liquid and liquid and after theyellow yellow solution yellow solution yellow yellow storage at powderpowder powder powder powder 40° C. sedim. sedim. sedim. sedim. sedim.Visual White White Orange White Brownish Light Orange Orange White Whiteinspection liquid and liquid and solution liquid and orange brownsolution solution liquid and liquid and after the yellow yellow yellowsolution solution yellow yellow storage at powder powder powder powderpowder 50° C. sedim. sedim. sedim. sedim. sedim. Compatibility Compat.Compat. Non Compat. Non Non Non Non Compat. Compat Results no no compat.no compat. compat. compat. compat. no no after the oxidation oxidationno oxidation oxidation oxidation oxidation oxidation oxidation oxidationstorage oxidation B. Mixtures of 1.04% w/w of Doxycycline Hyclate storedat 25° C., 40° C. and 50° C. for two weeks Ingredients Group I Cetearyloctanoate Hexylene glycol Butylene glycol Sorbitan Monolaurate DimethylIsosorbide Visual inspection bright yellow bright yellow bright yellowbright yellow yellow solution at T-0 solution solution solution mixtureVisual inspection bright yellow bright yellow bright yellow Brownsolution Yellow solution after the storage solution solution solution at25° C. Visual inspection bright yellow light yellow solution Lightorange Brown solution Brownish orange after the storage solutionsolution at 40° C. Visual inspection White liquid and Light yellowliquid Light orange Black solution Orange solution after the storageyellow powder sedim. and yellow powder solution at 50° C. sedim.Compatibility Compat. Compat. Non compat. Non compat. Non compat.Results no oxidation no oxidation oxidation oxidation Oxidation

Group II included Doxycycline Hyclate mixed with various vehicles withaddition of antioxidants like alpha tocopherol, butylated hydroxytoluene(BHT), and ascorbic acid.

TABLE 74 Doxycycline Hyclate Compatibility Test (Group II) Mixtures of1.04% w/w of Doxycycline Hyclate stored at 25° C., 40° C. and 50° C. fortwo weeks Ingredients Ethanol 95%, Propylene glycol, PEG 200, alphaEthanol 95% BHT and alpha tocopherol tocopherol and Group II Ethanol 95%and BHT ascorbic acid and ascorbic acid ascorbic acid Visual inspectionbright yellow bright yellow bright yellow bright yellow bright yellow atT-0 solution solution solution solution solution Visual inspectionbright yellow bright yellow Yellow solution bright yellow Yellowsolution after the storage at solution solution solution 25° C. Visualinspection bright yellow bright yellow Yellow solution Light orangeOrange after the storage at solution solution solution solution 40° C.Visual inspection bright yellow bright yellow Orange solution Lightorange Brownish after the storage at solution solution solution orangesolution 50° C. Compatibility compatible. compatible Non compatible. Noncompatible. non compatible. Results no oxidation no oxidation Oxidationoxidation Oxidation

TABLE 75 Doxycycline Hyclate Compatibility Test (Group III) Mixtures of1.04% w/w of Doxycycline Hyclate stored at 25° C., 40° C. and 50° C. for3 days Ingredients Myristyl Steareth alcohol and Isostearic Oleyl 20 andHydrogenated Stearyl PEG 40 PEG 100 Sorbitan Group II Acid alcoholSteareth 2 Castor Oil alcohol Stearate Stearate MonostearateCocoglycerides Visual inspection Yellow Yellow Yellow Yellow YellowYellow Yellow Yellow Yellow at T-0 suspen suspen suspen suspen suspensuspen suspen suspen suspen Visual inspection Yellow Yellow YellowYellow Yellow Yellow Yellow Yellow Yellow after the storage suspensuspen suspen suspen suspen suspen. suspen suspen suspen at 25° C.Visual inspection Yellow Yellow Brown Yellow Yellow Brown Yellow YellowYellow after the storage suspen suspen suspen suspen suspen suspensuspen suspen suspen at 40° C. Visual inspection Yellow Yellow BrownYellow Yellow Brown Yellow Yellow Light after the storage suspen suspensuspen suspen suspen suspen suspen suspen brown at 50° C. powderCompatibility Compat.. Compat. Non Compat. Compat. Non Compat.. Compat.Non Results no No compat. No No Compat. No No Compat. oxidationoxidation Oxidation oxidation oxidation oxidation oxidation oxidationoxidation Suspen. - suspension; compat. - compatible

A similar compatibility test was performed on another form ofDoxycycline—Doxycycline Monohydrate. The results are presented in Tables25A, 25B, and 26.

TABLE 76 Doxycycline Monohydrate Compatibility Test (Group I) A.Mixtures of 1.04% w/w of Doxycycline Monohydrate stored at 25° C., 40°C., and 50° C. for two weeks Ingredients PPG-15 stearyl PropyleneDiisopropyl Group I Cyclomethicone ether Octyldodecanol Mineral oilglycol Glycerol PEG 200 PEG 400 MCT oil adipate Visual White White WhiteWhite Light yellow yellow Dark White White inspection liquid and liquidand liquid and liquid and yellow solution solution yellow liquid andliquid and at T-0 yellow yellow yellow yellow solution solution yellowyellow powder powder powder powder powder powder sedim. sedim. sedim.sedim. sedim. sedim. Visual White White White White Orange yellowYellowish Yellowish White White inspection liquid and liquid and liquidand liquid and solution solution black brown liquid and liquid and afterthe yellow yellow yellow yellow solution solution yellow yellow storageat powder powder powder powder powder powder 25° C. sedim. sedim. sedim.sedim. sedim. sedim. Visual White Yellowish orange White Black blackBlack Brown White White inspection liquid and orange solution liquid andsolution solution solution solution liquid and liquid and after theyellow mixture yellow yellow yellow storage at powder powder powderpowder 40° C. sedim. sedim. sedim. sedim. Visual White Yellowish OrangeWhite black black Black Black Dirty Brown inspection liquid and orangesolution liquid and solution solution solution solution yellow mixtureafter the yellow mixture yellow storage at powder powder 50° C. sedim.sedim. Compatibility Compat. Non Non Compat. Non Non Non Non Non NonResults no compat. compat. no compat. compat. compat. compat. compat.compat. after the oxidation oxidation oxidation oxidation oxidationoxidation oxidation oxidation oxidation oxidation storage B. Mixtures of1.04% w/w of Doxycycline Monohydrate stored at 25° C., 40° C., and 50°C. for two weeks Ingredients Group I Cetearyl octanoate Hexylene glycolButylene glycol Sorbitan Monolaurate Dimethyl Isosorbide Visual Whiteliquid and yellow White liquid and yellow White liquid and Brown mixtureyellow solution inspection powder sedim. powder sedim. yellow powder atT-0 sedim. Visual White liquid and yellow bright yellow Orange solutionorange solution orange solution inspection powder sedim. solution afterthe storage at 25° C. Visual White liquid and yellow Brownish blacksolution Brownish black Brown solution orange solution inspection powdersedim. solution after the storage at 40° C. Visual White liquid andyellow Black solution. black solution brown solution Orange solutioninspection powder sedim. after the storage at 50° C. Compatibilitycompat. Non compat. Non compat. Non compat. non compat. Results nooxidation oxidation Oxidation oxidation Oxidation

TABLE 77 Doxycycline Monohydrate Compatibility Test (Group II) Mixturesof 1.04% w/w of Doxycycline Monohydrate stored at 25° C., 40° C., and50° C. for two weeks Ingredients Ethanol 95%, Propylene glycol, PEG 200,alpha Ethanol 95% BHT and alpha tocopherol tocopherol and Group IIEthanol 95% and BHT ascorbic acid and ascorbic acid ascorbic acid Visualinspection bright yellow bright yellow bright yellow bright yellowbright yellow at T-0 solution solution solution solution solution Visualinspection Brown solution Brown solution orange solution Yellowishorange Yellow solution after the storage at solution 25° C. Visualinspection Brown solution Brown solution Orange solution Orange solutionDark yellow after the storage at solution 40° C. Visual inspection Blacksolution Black solution Black solution Brownish orange Brown orangeafter the storage at solution solution 50° C. Compatibility Noncompatible. Non compatible Non compatible. Non compatible. noncompatible. Results oxidation oxidation Oxidation oxidation Oxidation

Interesting and unexpected phenomena were found during the compatibilitystudies of Minocycline HCl, Doxycycline Hyclate and DoxycyclineMonohydrate:

1. While minocycline displayed intensive oxidation on dissolution inglycerol, the antibiotic surprisingly revealed full compatibility withoctyldodecanol, a branched chain fatty alcohol. Both molecules havesimilar hydroxyl units in their structures.

2. Doxycycline Hyclate and Monohydrate unexpectedly revealed differentcompatibility with excipients. For example, Doxycycline Hyclate wasstable in a mixture with PPG-15 Stearyl Ether. Surprisingly, theDoxycycline Monohydrate was found to be non-compatible with PPG-15Stearyl Ether during the storage at 40° C. and 50° C. for two weeks.

3. Doxycycline Hyclate was stable in a mixture with ethanol 95% andhexylene glycol. Doxycycline Monohydrate oxidized in similar mixtures.

4. Unexpectedly, addition of strong anti-oxidants like alpha-tocopheroland ascorbic acid did not prevent the oxidation of any of MinocyclineHCl, Doxycycline Hyclate and Monohydrate in a waterless medium ofpropylene glycol and PEG 200.

5. Surprisingly, Doxycycline Hyclate revealed stability in Ethanol 95%following the storage at 40° C. and 50° C. for two weeks although bothMinocycline HCl and Doxycycline Monohydrate changed their color fromyellow to orange upon dissolution in Ethanol 95%.

6. In conclusion, the following non predictable substances were found tobe compatible with Minocycline and Doxycycline:

TABLE 78 Summary of MCH and DOX compatibility studies Compatibilitytested after the storage for up to 3 weeks Minocycline DoxycyclineDoxycycline Ingredient HCl Hyclate Monohydrate Comments Cyclomethicone 5NF Yes Yes Yes All compatible PPG-15 Stearyl Ether Yes Yes NoOctyldodecanol Yes No No Mineral Oil Yes Yes Yes All compatiblePropylene Glycol No No No Glycerol No No No PEG 200 No No No PEG 400 NoNo No MCT Oil Yes Yes No Diisopropyl adipate Yes Yes No Ethanol 95% NoYes No Isostearic acid No Yes Not tested Oleyl alcohol Yes Yes Nottested Steareth 20 (Polyoxyl 20 No No Not tested Stearyl Ether) Steareth2 (Polyoxyl 2 No No Not tested Stearyl Ether) Methyl glycose No Nottested Not tested sesquistearate (MGSS) Aluminum Starch Yes Not testedNot tested Octenylsuccinate (ASOS) Cetearyl octanoate Yes Yes Yes Allcompatible Hydrogenated Castor Oil Yes Yes Not tested Stearyl alcoholYes Yes Not tested Myristyl alcohol Yes Yes Not tested Titanium DioxideYes Not tested Not tested PEG 40 stearate Yes No Not tested PEG 100Stearate Yes Yes Not tested Sorbitan Monostearate Yes Yes Not testedCocoglycerides Yes No Not tested Coconut Alcohol Yes Not tested Nottested Hexylene glycol No Yes No Butylene glycol No No No SorbitanMonolaurate No No No Dimethyl Isosorbide No No No Titanium dioxide YesNot tested Not tested Methyl glycose No Not tested Not testedsesquistearate (MGSS) Aluminum Starch Yes Not tested Not testedOctenylsuccinate (ASOS) Coconut alcohol Yes Not tested Not tested

7. As could be seen from Table 76, not all of the ingredients compatiblewith MCH are compatible with Doxycycline Hyclate or Monohydrate. Forexample, octyldodecanol is compatible with Minocycline HCl but revealedincompatibility with Doxycycline Hyclate and Monohydrate. Surprisingly,there are discrepancies in the list of ingredients compatible withDoxycycline Hyclate and Doxycycline Monohydrate: for example, PPG-15Stearyl Ether is compatible with Doxycycline Hyclate and non-compatiblewith Doxycycline Monohydrate.

8. The data presented herein could be used for selection of activematerials from tetracycline family for topical formulations. A list ofingredients that were found to be compatible with MCH and DOX could beapplied to other antibiotics from the tetracycline family. The followingingredients are suitable for topical formulations: mineral oil,cyclomethicone, cetearyl octanoate. Few ingredients are compatible withboth forms of doxycycline and are also compatible with minocycline.

Example 8 Phase II Study for Papulopustular Rosacea

A double-blind, randomized, placebo-controlled Phase 2 trial has beencarried out involving 233 patients who were enrolled in 18 sitesthroughout Germany. Patients were randomized (1:1:1) to receive highdose FMX103 (3% minocycline foam), low dose FMX103 (1.5% minocyclinefoam) or vehicle foam once daily (in the evening) over 12 weeks,followed up by a 4-week post-treatment evaluation. However, one subjectin the 3% group did not receive treatment and was not included in theintent to treat analysis. The study medication, dosage,inclusion/exclusion criteria, and design generally followed thoseoutlined in Example 3 above, with the inclusion criteria of healthymales or non-pregnant female aged over 18, having at least 12 papulesand/or pustules for more than 6 months, and having the Investigator'sGlobal Assessment (IGA) scores moderate to severe. The mean age of thestudy participants was 52.5 and 63% of the participants were female (seeTable 79A and B). The efficacy endpoints were the absolute change in thenumber of inflammatory facial lesions (papules and pustules (primaryendpoint)), improvement of the IGA of severity at 12 weeks compared tobaseline (first secondary endpoint), and percent change in inflammatorylesion count at week 12 compared to baseline (second secondaryendpoint). IGA score improvement by 2 or more grades and reaching an IGAscore of 0 (“clear”) or 1 (“almost clear”) were considered successful.Safety and tolerability in the treatment of moderate to severepapulopustular rosacea were also evaluated. Safety and efficacyevaluations were performed at week 2, 4, 8, and 12, with an additionalsafety follow-up visit at week 16.

TABLE 79A Summary of Analysis Populations by Treatment Minocycline 1.5%Minocycline 3% Vehicle Overall n (%) n (%) n (%) n (%) Screened 79 76 78233 Randomized 79 76 78 233 Randomized but not treated^(a)  0  1  0  1Intent-to-Treat Population^(b,c)  79 (100.0) 75 (98.7)  78 (100.0) 232(99.6) Per-Protocol Population^(b,d) 72 (91.1) 63 (82.9) 69 (88.5) 204(87.6) Excluded from the Per-Protocol 7 (8.9) 13 (17.1)  9 (11.5)  29(12.4) Population^(e) Not in ITT population  0 1 (1.3)  0  1 (0.4)Discontinued from the study 2 (2.5) 10 (13.2) 7 (9.0) 19 (8.2) Had majordeviations from 5 (6.3) 2 (2.6) 2 (2.6)  9 (3.9) protocol SafetyPopulation  79 (100.0) 75 (98.7)  78 (100.0) 232 (99.6) ^(a)Subject wasrandomized in error. Baseline inflammatory lesion count was 7, belowinclusion criteria of 12. Subject was not dispensed study drug and wasnot included in the intent-to-treat population. Incomplete baselineassessment was done. ^(b)Percentages are based on the number of subjectsrandomized. ^(c)Includes all randomized subjects. ^(d)Includes all ITTsubjects without any major deviations from the protocol. ^(e)Subjectsmay be excluded for more than one reason.

TABLE 79B Summary of Demographics and Baseline Characteristics byTreatment - ITT Population Minocycline Minocycline 1.5% 3% VehicleOverall Parameter (N = 79) (N = 75) (N = 78) (N = 232) Mean Age years(range) Range 21-82 22-78 24-80 21-82 Mean (SD) 51.2 (15.26) 51.6(14.15) 54.8 (14.05) 52.5 (14.53) Median 51.0 52.0 53.5 52.0 AgeCategories (years), [n (%)] 18-30 13 (16.5) 7 (9.3) 5 (6.4) 25 (10.8)31-50 25 (31.6) 28 (37.3) 27 (34.6) 80 (34.5) >50 41 (51.9) 40 (53.3) 46(59.0) 127 (54.7)  Sex, [n (%)] Male 26 (32.9) 24 (32.0) 37 (47.4) 87(37.5) Female 53 (67.1) 51 (68.0) 41 (52.6) 145 (62.5)  Race, [n (%)]Caucasian 98.7 97.3 100.0 98.7 Other^(a) 1.3 2.7 0 1.3 Female ofChildbearing Potential (Females only), [n (%)] Yes 29 (54.7) 21 (41.2)18 (43.9) 68 (46.9) No 24 (45.3) 30 (58.8) 23 (56.1) 77 (53.1) IGA ofrocasea,^(b) % Moderate 43.0 38.7 51.3 44.4 (IGA = 3) Severe 57.0 61.348.7 55.6 (IGA = 4) Mean range) 34.5 13-125) 34.1 12-186) 30.6 12-91)33.1 12-186) total inflammatory lesion count ^(a)FMX-103 1.5% n = 1Other; FMX-103 3%:n = 1American Indian or Alaska Native, n = 1 NativeHawaiian or Other Pacific Islander. ^(b)IGA grading for rosacea: 0 =clear; 1 = almost clear; 2 = mild; 3 = moderate; 4 = severe.

Study Baseline.

The mean baseline lesion count for all groups ranged from 30.6 to 34.5and the IGA scores were all moderate (score 3) or severe (score 4), withabout 50% to about 60% of the subjects having a severe rating (Table 80Aand C). Table 80B summarizes the IGA score system.

TABLE 80A Summary of Subject Disposition by Treatment - ITT PopulationMinocycline 1.5% Minocycline 3% Vehicle Overall (N = 79) (N = 75) (N =78) (N = 232) Completion Status n (%) n (%) n (%) n (%) Treated (atleast one treatment)  79 (100.0)  75 (100.0)  78 (100.0)  232 (100.0)Completed at least 4 weeks of 76 (96.2) 68 (90.7) 73 (93.6) 217 (93.5)Treatment Completed 12 weeks of 74 (93.7) 60 (80.0) 67 (85.9) 201 (86.6)Treatment Completed Treatment and 73 (92.4) 60 (80.0) 67 (85.9) 200(86.2) Follow-up^(a) Discontinued 2 (2.5) 10 (13.3) 7 (9.0) 19 (8.2)Adverse Event 0 3 (4.0) 1 (1.3)  4 (1.7) Abnormal Laboratory Result 0 00 0 Lost to Follow-up 1 (1.3) 0 0  1 (0.4) Subject Request 1 (1.3) 6(8.0) 3 (3.8) 10 (4.3) Protocol Deviation 0 1 (1.3) 1 (1.3)  2 (0.9)Specific Medical Reasons 0 0 0 0 Other 0 0 2 (2.6)  2 (0.9) ^(a)Includessubjects who completed 12 weeks of treatment and had the follow-upvisit.

TABLE 80B IGA grading scale for papulopustular rosacea Grade ScoreDescription Clear 0 No inflammatory papules or pustules Almost 1 1 or 2inflammatory papules or pustules clear Mild 2 3 to 11 inflammatorypapules or pustules Moderate 3 12 to 19 inflammatory papules or pustulesand no nodules Severe 4 ≥20 inflammatory papules or pustules, and up to2 nodules IGA = Investigator's Global Assessment.

TABLE 80C Summary of Baseline Rosacea IGA and Total Inflammatory LesionCount by Treatment - ITT Population Minocycline Minocycline 1.5% 3%Vehicle Overall Parameter (N = 79) (N = 75) (N = 78) (N = 232)Investigator Global Assessment (IGA) of Rosacea, [n (%)] Clear 0 0 0 0Almost Clear 0 0 0 0 Mild 0 0 0 0 Moderate 34 (43.0) 29 (38.7) 40 (51.3)103 (44.4) Severe 45 (57.0) 46 (61.3) 38 (48.7) 129 (55.6) TotalInflammatory Lesion Count Mean (SD) 34.5 (20.89) 34.1 (24.99) 30.6(15.48)  33.1 (20.74) Median 28.0 27.0 26.0 27.5 Min, Max 13, 125 12,186 12, 91 12, 186

Results:

232 subjects were randomized and received at least one dose of studydrug (ITT population). 201 (86.6%) subjects completed 12 weeks oftreatment and the follow-up visit. Statistically significant improvementvs. vehicle in the two most important measurements of efficacy wasdemonstrated for both FMX-103 doses. At the week 12 time point,designated for the primary end point analysis, both the 1.5% and 3%doses of FMX103 significantly reduced the absolute number of papules andpustules vs. the vehicle (1.5% and 3%, both p<0.001, ANCOVA,intent-to-treat analysis). The mean reduction in inflammatory lesioncount (absolute change) of each treatment group vs. its baseline was21.1 for the 1.5% dose, 19.9 for the 3% dose, and 7.8 for vehicle (FIG.1A; Table 81A). The corresponding percent reductions were 61.4% and55.5% for the FMX103 1.5% and 3% groups, respectively, and 29.7% for thevehicle (1.5% and 3%, both p<0.001, ANCOVA, intent-to-treat analysis).(FIG. 1B; Table 81A). A significant reduction in the mean lesion countwas observed as early as week 2 for both 1.5% and 3% doses of FMX103 vs.the vehicle (1.5% and 3%, p<0.01, p<0.05 respectively ANCOVA,intent-to-treat analysis). The mean reduction in inflammatory lesioncount (absolute change) of each treatment group vs. its baseline was10.9 for the 1.5% dose, 9 for the 3% dose, and 4 for vehicle. (see FIG.1A; Table 81B). The corresponding percent reductions were 30% and 26%for the FMX103 1.5% and 3% groups, respectively, and 16% for the vehicle(1.5% p<0.01, ANCOVA, intent-to-treat analysis) (see FIG. 1B; Table81C).

TABLE 81A Summary of Percent and Absolute Change from Baseline inInflammatory Lesion Count at Week 12 by Treatment in the Intent-to-TreatPopulation (Multiple Imputation Method) Minocycline 1.5% Minocycline 3%Vehicle Parameter (N = 79) (N = 75) (N = 78) Baseline N 79 75 78 Mean(SD)  34.5 (20.89)  34.1 (24.99)  30.6 (15.48) Median 28.0 27.0 26.0Min, Max 13, 125 12, 186 12, 91 Week 12 N 79 75 78 Mean (SD)  13.4(13.96)  14.2 (12.44)  22.8 (22.21) Median 9.0 12.9 16.8 Min, Max 0, 900, 57  0, 154 Percent Change from Baseline (%) N 79 75 78 Mean (SD)−61.4 (32.29) −55.5 (31.38) −29.7 (46.34) Median −69.6 −60.9 −37.8 Min,Max −100.0, 44.4   −100.0, 11.2   −100.0, 165.5  LSMean (SE)^(a) −64.5(4.55)  −58.5 (4.94)  −32.0 (4.83)  P-value^(a) <0.001 <0.001 AbsoluteChange from Baseline N 79 75 78 Mean (SD) −21.1 (17.79) −19.9 (20.38) −7.8 (17.37) Median −17.0 −14.0 −8.0 Min, Max −95, 12  −129, 2   −44,96  LSMean (SE)^(a) −21.2 (1.68)  −20.3 (1.75)  −9.9 (1.80) P-value^(a)<0.001 <0.001 Interaction P-value^(b): 0.665 Homogeneity P-value^(c):0.267 Normality P-value^(d): <0.001 Non-parametric <0.001 <0.001 ANCOVAP-value^(e) ^(a)From an analysis of covariance with main effect oftreatment and covariates of baseline and pooled site. P-value is thetest result for treatment effect versus vehicle. ^(b)P-value fortreatment by pooled site, based on analysis of covariance on unimputeddata with effects of treatment, baseline, and pooled site, and treatmentby pooled site interaction. ^(c)From Levene's test on unimputed data.^(d)From Shapiro-Wilk test on unimputed data. ^(e)From a non-parametricANCOVA with effects of treatment, baseline, and pooled site.

TABLE 81B Summary of Absolute Change from Baseline in InflammatoryLesion Count Visits 2, 4 and 8 by Treatment in the Intent-to-TreatPopulation (Multiple Imputation Method) Visit Minocycline 1.5%Minocycline 3% Vehicle Parameter (N = 79) (N = 75) (N = 78) Baseline N79 75 78 Mean (SD) 34.5 (20.89) 34.1 (24.99) 30.6 (15.48) Median 28.027.0 26.0 Min, Max 13, 125 12, 186 12, 91  Week 2 N 79 75 78 Mean (SD)23.6 (15.20) 25.2 (21.14) 26.7 (17.83) Median 21.0 19.0 23.5 Min, Max 0,74  2, 152  1, 103 Week 2 Change from Baseline N 79 75 78 Mean (SD)−10.9 (14.71) −9.0 (14.57) −4.0 (10.95) Median −8.0 −7.0 −4.0 Min, Max−75, 31  −82, 24  −30, 59  LSMean (SE)^(a) −11.2 (1.36) −9.2 (1.40) −5.3(1.37) P-value^(a) 0.002 0.038 Week 4 N 79 75 78 Mean (SD) 19.8 (16.14)19.3 (19.72) 25.1 (16.38) Median 14.0 15.0 21.0 Min, Max 0, 76  1, 1480, 81 Week 4 Change from Baseline N 79 75 78 Mean (SD) −14.8 (16.40)−14.8 (15.00) −5.5 (9.06) Median −13.0 −12.0 −7.0 Min, Max −81, 29  −84,20  −22, 23  LSMean (SE)^(a) −14.6 (1.36) −14.7 (1.42) −6.6 (1.36)P-value^(a) <0.001 <0.001 Week 8 N 79 75 78 Mean (SD) 16.0 (14.51) 15.2(15.30) 23.1 (17.60) Median 11.2 11.0 18.5 Min, Max 0, 79 0, 96 0, 86Week 8 Change from Baseline N 79 75 78 Mean (SD) −18.5 (17.71) −18.9(17.60) −7.6 (13.45) Median −16.0 −17.0 −8.4 Min, Max −85, 29  −90, 16 −39, 32  LSMean (SE)^(a) −18.4 (1.46) −19.0 (1.52) −9.3 (1.49)P-value^(a) <0.001 <0.001 ^(a)From an analysis of covariance with maineffect of treatment and covariates of baseline and pooled site. P-valueis the test result for treatment effect versus vehicle.

TABLE 81C Summary of Percent Change from Baseline in Inflammatory LesionCount Visits 2, 4 and 8 by Treatment in the Intent-to-Treat Population(Multiple Imputation Method) Visit Minocycline 1.5% Minocycline 3%Vehicle Parameter (N = 79) (N = 75) (N = 78) Baseline N 79 75 78 Mean(SD) 34.5 (20.89) 34.1 (24.99) 30.6 (15.48) Median 28.0 27.0 26.0 Min,Max 13, 125 12, 186 12, 91  Week 2 N 79 75 78 Mean (SD) 23.6 (15.20)25.2 (21.14) 26.7 (17.83) Median 21.0 19.0 23.5 Min, Max 0, 74  2, 152 1, 103 Week 2 Percent Change from Baseline (%) N 79 75 78 Mean (SD)−30.0 (34.05) −25.9 (31.68) −15.8 (32.54) Median −29.6 −29.2 −16.7 Min,Max −100.0, 114.8  −87.2, 104.3  −91.7, 134.1  LSMean −32.1 (3.83) −27.5(3.93) −17.3 (3.90) (SE)^(a) P-value^(a) 0.005 0.053 Week 4 N 79 75 78Mean (SD) 19.8 (16.14) 19.3 (19.72) 25.1 (16.38) Median 14.0 15.0 21.0Min, Max 0, 76  1, 148 0, 81 Week 4 Percent Change from Baseline (%) N79 75 78 Mean (SD) −42.9 (37.25) −44.1 (28.20) −20.1 (33.68) Median−46.7 −46.0 −19.8 Min, Max −100.0, 107.4  −94.4, 32.8  −100.0, 100.0 LSMean −44.5 (3.95) −45.5 (4.14) −20.9 (3.97) (SE)^(a) P-value^(a)<0.001 <0.001 Week 8 N 79 75 78 Mean (SD) 16.0 (14.51) 15.2 (15.30) 23.1(17.60) Median 11.2 11.0 18.5 Min, Max 0, 79 0, 96 0, 86 Week 8 PercentChange from Baseline (%) N 79 75 78 Mean (SD) −53.3 (36.17) −53.8(34.33) −26.3 (37.78) Median −63.6 −58.1 −28.3 Min, Max −100.0, 107.4 −100.0, 71.4   −100.0, 69.7   LSMean −54.9 (4.36) −55.2 (4.54) −27.5(4.41) (SE)^(a) P-value^(a) <0.001 <0.001 ^(a)From an analysis ofcovariance with main effect of treatment and covariates of baseline andpooled site. P-value is the test result for treatment effect versusvehicle.

Moreover, treatment resulted in significant improvement in IGA scores(FIGS. 2A and 2B; Tables 82A and 82B). Both the 1.5% and 3% doses ofFMX-103 were significantly better compared to vehicle in reducing theIGA score by 2 grades and in reaching a “clear” (score=0) or “almostclear” (score=1) rating at Week 12, Both the 1.5% and 3% doses wereefficacious and there was no statistically significant differencebetween the two minocycline doses.

The results indicate that both the 1.5% and 3% doses of FMX-103 weresignificantly better than the vehicle in improving IGA scores by atleast 2 grades at Week 12 (p=0.002 and p=0.032, respectively FIG. 2A,Table 82B). Both active doses of FMX-103 were also significantly betterthan the vehicle in improving the IGA scores by at least 2 grades andachieving an IGA score of “clear” (score=0) or “almost clear” (score=1)at Week 12 (p=0.001 and p=0.041 for 1.5% and 3% FMX-103, respectivelyFIG. 2B, Table 82B).

The percent of subjects with improvement of IGA score by 2 grades atWeek 12 was 41.8% and 33.3% for the FMX103 1.5% and 3% groups,respectively, and 17.9% for the vehicle (P<0.01 and P<0.05,respectively, Cochran-Mantel-Haenszel test). FIG. 2A; Tables 82A)

The percent of subjects with improvement of IGA score by 2 grades and inreaching a “clear” (score=0) or “almost clear” (score=1) at Week 12 was25.3% and 17.3% for the FMX103 1.5% and 3% groups, respectively, and7.7% for the vehicle (P<0.01 and P<0.05, respectively,Cochran-Mantel-Haenszel test FIG. 2B; Tables 82B)

Both the 1.5% and 3% doses of FMX-103 were significantly better comparedto vehicle in reducing the IGA score by 2 grades as early as Week 4(P<0.001 and P<0.01, respectively, Cochran-Mantel-Haenszel test FIG. 2A;Tables 82C). The percent improvement of IGA score by 2 grades at Week 4was 20.3% and 18.7% for the FMX103 1.5% and 3% groups, respectively, and2.6% for the vehicle.

Both the 1.5% and 3% doses of FMX-103 were significantly better comparedto vehicle in reducing the IGA score by 2 grades resulting in “clear” or“almost clear” as early as Week 8 (P<0.01 and P<0.05, respectively,Cochran-Mantel-Haenszel test FIG. 2B; Table 82D). The percentimprovement of IGA score by 2 grades at Week 8 was 16.5% and 14.7% forthe FMX103 1.5% and 3% groups, respectively, and 3.8% for the vehicle.

TABLE 82A Summary of Investigator Global Assessment (IGA) 2-LevelImprovement from Baseline to Week 12 by Treatment in the Intent-to-TreatPopulation (Multiple Imputation Method) Minocycline Minocycline 3%Vehicle 1.5% (N = 79) (N = 75) (N = 78) Parameter n (%) n (%) n (%)Baseline Clear 0 0 0 Almost Clear 0 0 0 Mild 0 0 0 Moderate 34 (43.0) 29(38.7) 40 (51.3) Severe 45 (57.0) 46 (61.3) 38 (48.7) Week 12 Clear 7(8.9) 2 (2.7) 1 (1.3) Almost Clear 13 (16.5) 11 (14.7) 5 (6.4) Mild 29(36.7) 26 (34.7) 25 (32.1) Moderate 12 (15.2) 17 (22.7) 18 (23.1) Severe18 (22.8) 19 (25.3) 29 (37.2) Severe Cases Change −60% −58.7% −23.7%Change from Baseline Improvement observed 58 (73) 53 (70.66) 35 (45)Improved by 4 Levels 1 (1.3) 0 0 Improved by 3 Levels 10 (12.7) 6 (8.0)1 (1.3) Improved by 2 Levels 22 (27.8) 19 (25.3) 13 (16.7) Improved by 1Level 25 (31.6) 28 (37.3) 21 (26.9) No Improvement 21 (26.6) 20 (26.7)40 (51.3) Worsened by 1 Level 0 2 (2.7) 3 (3.8) Worsened by 2 Levels 0 00 Improved at Least 2 33 (41.8) 25 (33.3) 14 (17.9) Levels Did NotImprove at 46 (58.2) 50 (66.7) 64 (82.1) Least 2 Levels P-value^(a)0.002 0.032 Investigator Global Assessment (IGA) scores are 0-4 (Clearto Severe) ^(a)From a CMH test stratified by pooled site. Only treatmentgroups being compared included in the analysis.

TABLE 82B Summary of Investigator Global Assessment (IGA) 2-LevelImprovement that Results in Clear or Almost Clear from Baseline to Week12 by Treatment Intent-to-Treat Population (Multiple Imputation Method)Clear or Almost Clear Minocycline 1.5% Minocycline 3% Vehicle andImproved at (N = 79) (N = 75) (N = 78) Least 2 Levels n (%) n (%) n (%)Yes 20 (25.3) 13 (17.3) 6 (7.7) No 59 (74.7) 62 (82.7) 72 (92.3)P-Value^(a) 0.001 0.041 Investigator Global Assessment (IGA) scores are0-4 (Clear to Severe) ^(a)From a CMH test stratified by pooled site.Only treatment groups being compared included in the analysis.

TABLE 82C Summary of Investigator Global Assessment (IGA) 2-LevelImprovement from Baseline Visits 2, 4 and 8 and Treatment in theIntent-to-Treat Population (Multiple Imputation Method) MinocyclineMinocycline 1.5% 3% Vehicle Visit (N = 79) (N = 75) (N = 78) Parameter n(%) n (%) n (%) Baseline Clear 0 0 0 Almost Clear 0 0 0 Mild 0 0 0Moderate 34 (43.0) 29 (38.7) 40 (51.3) Severe 45 (57.0) 46 (61.3) 38(48.7) Week 2 Clear 1 (1.3) 0 0 Almost Clear 1 (1.3) 2 (2.7) 2 (2.6)Mild 19 (24.1) 15 (20.0) 12 (15.4) Moderate 23 (29.1) 27 (36.0) 32(41.0) Severe 35 (44.3) 31 (41.3) 32 (41.0) Week 2 Change from BaselineImproved by 4 Levels 0 0 0 Improved by 3 Levels 1 (1.3) 0 0 Improved by2 Levels 4 (5.1) 4 (5.3) 2 (2.6) Improved by 1 Level 25 (31.6) 28 (37.3)19 (24.4) No Improvement 47 (59.5) 41 (54.7) 56 (71.8) Worsened by 1Level 2 (2.5) 2 (2.7) 1 (1.3) Worsened by 2 Levels 0 0 0 Improved atLeast 2 5 (6.3) 4 (5.3) 2 (2.6) Levels Did Not Improve at 74 (93.7) 71(94.7) 76 (97.4) Least 2 Levels P-Value^(a) 0.239 0.363 Week 4 Clear 1(1.3) 0 1 (1.3) Almost Clear 6 (7.6) 5 (6.7) 1 (1.3) Mild 25 (31.6) 22(29.3) 16 (20.5) Moderate 21 (26.6) 23 (30.7) 27 (34.6) Severe 26 (32.9)25 (33.3) 33 (42.3) Week 4 Change from Baseline Improved by 4 Levels 0 00 Improved by 3 Levels 2 (2.5) 0 1 (1.3) Improved by 2 Levels 14 (17.7)14 (18.7) 1 (1.3) Improved by 1 Level 26 (32.9) 27 (36.0) 23 (29.5) NoImprovement 36 (45.6) 33 (44.0) 51 (65.4) Worsened by 1 Level 1 (1.3) 1(1.3) 2 (2.6) Worsened by 2 Levels 0 0 0 Improved at Least 2 16 (20.3)14 (18.7) 2 (2.6) Levels Did Not Improve at 63 (79.7) 61 (81.3) 76(97.4) Least 2 Levels P-Value^(a) <0.001 0.001 Week 8 Clear 3 (3.8) 4(5.3) 1 (1.3) Almost Clear 10 (12.7) 7 (9.3) 2 (2.6) Mild 29 (36.7) 29(38.7) 23 (29.5) Moderate 15 (19.0) 16 (21.3) 21 (26.9) Severe 22 (27.8)19 (25.3) 31 (39.7) Week 8 Change from Baseline Improved by 4 Levels 0 1(1.3) 0 Improved by 3 Levels 6 (7.6) 5 (6.7) 1 (1.3) Improved by 2Levels 16 (20.3) 20 (26.7) 7 (9.0) Improved by 1 Level 32 (40.5) 26(34.7) 24 (30.8) No Improvement 24 (30.4) 22 (29.3) 42 (53.8) Worsenedby 1 Level 1 (1.3) 1 (1.3) 4 (5.1) Worsened by 2 Levels 0 0 0 Improvedat Least 2 22 (27.8) 26 (34.7) 8 (10.3) Levels Did Not Improve at 57(72.2) 49 (65.3) 70 (89.7) Least 2 Levels P-Value^(a) 0.004 <0.001^(a)From a CMH test stratified by pooled site. Only treatment groupsbeing compared are included in the analysis. Source: Listing 16.2.10.1

TABLE 82D Summary of Investigator Global Assessment (IGA) 2-LevelImprovement from Baseline that Results in Clear or Almost Clear Visits2, 4 and 8 and Treatment in the Intent-to-Treat Population (MultipleImputation Method) Visit Clear or Almost Clear Minocycline 1.5%Minocycline 3% Vehicle and Improved at (N = 79) (N = 75) (N = 78) Least2 Levels n (%) n (%) n (%) Week 2 Yes 2 (2.5) 2 (2.7) 2 (2.6) No 77(97.5) 73 (97.3) 76 (97.4) P-Value^(a) >0.999 0.933 Week 4 Yes 7 (8.9) 5(6.7) 2 (2.6) No 72 (91.1) 70 (93.3) 76 (97.4) P-Value^(a) 0.055 0.155Week 8 Yes 13 (16.5) 11 (14.7) 3 (3.8) No 66 (83.5) 64 (85.3) 75 (96.2)P-Value^(a) 0.009 0.014 ^(a)From a CMH test stratified by pooled site.Only treatment groups being compared are included in the analysis.

Safety and Tolerability:

Both doses of FMX103 appeared to be generally safe and well-tolerated.There were no serious treatment-related systemic adverse events, andthere were only a few subjects overall who reported anytreatment-related AEs (2, 4, and 5 in the 1.5%, 3%, and vehicle groups,respectively). Overall, 47% (109/232) of subjects reported ≥1treatment-emergent AE (TEAE) (Table 83). The most common TEAEs (≥2% ofsubjects) included nasopharyngitis, urinary tract infection, cystitis,bronchitis (Table 84). 11 (4.7%) subjects reported treatment-relatedTEAEs, 9 had treatment-related dermal reactions (Tables 83 and Table85). These reactions resolved before the end of the study. Serious TEAEswere reported in 4 subjects (3 in FMX-103 group and 1 in vehicle group)(Tables 83, and Table 85), however there were no treatment-relatedsystemic TEAEs reported. In the FMX103 1.5% group, two subjects reportedserious TEAEs (one had a contusion and one had a cerebral hemorrhage,hemiparesis, and a pulmonary embolism), and in the FMX103 3% group, onesubject reported a serious TEAE (hemorrhoids). In the vehicle group, onesubject reported a serious TEAE (gastroenteritis). None of these wasconsidered to be treatment-related. A total of 4 subjects discontinuedthe study due to an adverse event (3 in the 3% group and 1 in thevehicle group (Table 83 and Table 85). All of these discontinued due todermal-related TEAE skin (one subject in the vehicle group had pruritusand skin burning sensation; three subjects in the FMX103 3% group eachhad eczema, burning sensation, or worsening of rosacea), and allresolved by the end of the study (Table 83 and Table 85). Treatmentappeared to be well tolerated; the severity of local signs and symptomsappeared to be similar between treatment groups.

TABLE 83 Summary of Safety Profile Minocycline 1.5% Minocycline 3%Vehicle Overall Overall Summary of TEAEs, n (N = 79) (N = 75) (N = 78)(N = 232) (%) n (%) n (%) n (%) n (%) Subjects with 1 or more TEAE 46(58.2) 32 (42.7) 31 (39.7) 109 (47.0)  Subjects with 1 or moretreatment- 2 (2.5) 4 (5.3) 5 (6.4) 11 (4.7)  related TEAE^(ab)Treatment-Related Dermal 1 (1.3) 4(5.3) 5 (6.4) 10 (4.3)  TEAEs^(c)Subjects with 1 or more severe 3 (3.8) 2 (2.7) 4 (5.1) 9 (3.9) TEAESubjects with 1 or more TEAE 0 3 (4.0) 1 (1.3) 4 (1.7) leading to studydiscontinuation^(b) Subjects with 1 or more serious 2 (2.5) 1 (1.3) 1(1.3) 4 (1.7) TEAE^(b) Safety population includes all randomizedsubjects who applied at least one dose of study drug ^(a)Includesunassessable, possible, probable, and certainly related adverse events^(b)Includes skin and subcutaneous tissue disorders, and generaldisorders and administration-site conditions (i.e, application-siteerythema). ^(c)Subjects experiencing ≥1 AEs are counted only once foreach AE term.

TABLE 84 Profile of Commmon Treatment-Emergent Adverse Events ThatOccured in ≥2% of Subjects and Treatmet Related Dermal TEAES Minocycline1.5% (N = 79) Minocycline 3% (N = 75) Vehicle (N = 78) System OrganClass Subjects^(a) Events Subjects^(a) Events Subjects^(a) EventsPreferred Term n (%) n n (%) n n (%) n Any Adverse Event Overall 26(32.9) 32 13 (17.3) 19 16 (20.5) 19 Infections and infestationsNasopharyngitis 11 (13.9) 11 3 (4.0) 3 9 (11.5) 9 Urinaiy tractinfection 3 (3.8) 3 2 (2.7) 2 3 (3.8) 3 Cystitis 2 (2.5) 3 2 (2.7) 2 0 0Bronchitis 3 (3.8) 3 0 0 0 0 Urinaiy tract infection bacterial 2 (2.5) 20 0 0 0 Influenza 0 0 0 0 2 (2.6) 3 Skin and subcutaneous tissuedisorders Worsening of rosacea as 2 (2.5) 2 3 (4.0) 4 0 0 compared tobaseline Eczema 2 (2.5) 2 2 (2.7) 2 2 (2.6) 2 Vascular disordersHypertension 2 (2.5) 2 2 (2.7) 2 2 (2.6) 2 Eye disorders Eczema eyelids2 (2.5) 2 0 0 0 0 Gastrointestinal disorders Toothache 2 (2.5) 2 0 0 0 0Nervous system disorders Headache 0 0 2 (2.7) 4 0 0 ^(a)Subjectsexperiencing one or more adverse events are counted only once for eachadverse event term.

TABLE 85 Summary of treatment-related dermal reactions, serious TEAEs,and TEAE leading to study discontinuation FMX- FMX- 103 1.5% 103 3%Vehicle (n = 79) (n = 75) (n = 78) Subjects with treatment-related 1(1.3) 3 (4.0) 5 (6.4) TEAEs^(a,) n (%) Skin and subcutaneous tissuedisorders Worsening of rosacea as 0 2 (2.7) 0 compared to baselineEczema 0 1 (1.3) 1 (1.3) Skin exfoliation 0 1 (1.3) 0 Erythema 0 0 1(1.3) Pruritus 0 0 1 (1.3) Scab 0 0 1 (1.3) Skin burning sensation 0 0 1(1.3) Spotted redness in treatment area 1 (1.3) 0 0 Redness aftermedication application 0 0 1 (1.3) Face-burning or stinging 0 1 (1.3) 0Eye disorders Eye discharge 1 (1.3) 0 0 Subjects with ≥1 serious 2 (2.5)1 (1.3) 1 (1.3) TEAE^(a), n (1%) Haemorrhoids 0 1 (1.3) 0 Contusion 1(1.3) 0 0 Cerebral haemorrhage 1 (1.3) 0 0 Hemiparesis 1 (1.3) 0 0Pulmonary embolism 1 (1.3) 0 0 Gastroenteritis 0 0 1 (1.3) Subjects with≥1 TEAE leading 0 3 (4.0) 1 (1.3) to study discontinuation n (%)^(a,b)Eczema 0 1 (1.3) 0 Worsening of rosacea as 0 1 (1.3) 0 compared tobaseline Pruritus 0 0 1 (1.3) Skin burning sensation 0 0 1 (1.3) Faceburning or stinging 0 1 (1.3) 0 Safety population includes allrandomized subjects who applied at least one dose of study drug.^(a)Subjects experiencing ≥1 AEs are counted only once for each AE term.^(b)Eczema, rosacea, pruritus, face burning or stinging, and skinburning sensation were classed as skin and subcutaneous tissue disorders(TEAE dermal related).

TABLE 86 Summary of Post-Baseline Local Safety Assessments by TreatmentSafety Population Minocycline 1.5% Minocycline 3% Vehicle Scale (N = 79)(N = 75) (N = 78) Visit n (%) n (%) n (%) Telangiectasis Week 2 None 21(26.6)  8 (10.7) 10 (12.8) Mild 39 (49.4) 42 (56.0) 41 (52.6) Moderate19 (24.1) 20 (26.7) 22 (28.2) Severe 0 1 (1.3) 2 (2.6) None or Mild 60(75.9) 50 (66.7) 51 (65.4) Week 4 None 20 (25.3) 11 (14.7)  9 (11.5)Mild 39 (49.4) 42 (56.0) 39 (50.0) Moderate 20 (25.3) 14 (18.7) 24(30.8) Severe 0 1 (1.3) 2 (2.6) None or Mild 59 (74.7) 53 (70.7) 48(61.5) Week 8 None 20 (25.3) 13 (17.3) 11 (14.1) Mild 38 (48.1) 37(49.3) 32 (41.0) Moderate 19 (24.1) 15 (20.0) 26 (33.3) Severe 0 0 2(2.6) None or Mild 58 (73.4) 50 (66.7) 43 (55.1) Week 12 None 22 (27.8)14 (18.7) 11 (14.1) Mild 42 (53.2) 42 (56.0) 33 (42.3) Moderate 14(17.7) 16 (21.3) 31 (39.7) Severe 0 1 (1.3) 2 (2.6) None or Mild 64(81.0) 56 (74.7) 44 (56.4) Burning/Stinging Week 2 None 53 (67.1) 37(49.3) 38 (48.7) Mild 17 (21.5) 24 (32.0) 24 (30.8) Moderate  8 (10.1) 8 (10.7) 11 (14.1) Severe 1. (1.3)  2 (2.7) 2 (2.6) None or Mild 70(88.6) 61 (81.3) 62 (79.5) Week 4 None 50 (63.3) 47 (62.7) 42 (53.8)Mild 20 (25.3) 14 (18.7) 23 (29.5) Moderate 7 (8.9) 7 (9.3)  9 (11.5)Severe 2 (2.5) 0 0 None or Mild 70 (88.6) 61 (81.3) 65 (83.3) Week 8None 58 (73.4) 50 (66.7) 40 (51.3) Mild 14 (17.7) 13 (17.3) 22 (28.2)Moderate 5 (6.3) 1 (1.3)  8 (10.3) Severe 0 1 (1.3) 1 (1.3) None or Mild72 (91.1) 63 (84.0) 62 (79.5) Week 12 None 55 (69.6) 54 (72.0) 45 (57.7)Mild 19 (24.1) 13 (17.3) 27 (34.6) Moderate 4 (5.1) 5 (6.7) 5 (6.4)Severe 0 1 (1.3) 0 None or Mild 74 (93.7) 67 (89.3) 72 (92.3)Flushing/Blushing Week 2 None 42 (53.2) 35 (46.7) 27 (34.6) Mild 22(27.8) 23 (30.7) 25 (32.1) Moderate 13 (16.5) 10 (13.3) 18 (23.1) Severe2 (2.5) 3 (4.0) 5 (6.4) None or Mild 64 (81.0) 58 (77.3) 52 (66.7) Week4 None 45 (57.0) 40 (53.3) 23 (29.5) Mild 22 (27.8) 18 (24.0) 31 (39.7)Moderate 7 (8.9)  8 (10.7) 18 (23.1) Severe 5 (6.3) 2 (2.7) 2 (2.6) Noneor Mild 67 (84.8) 58 (77.3) 54 (69.2) Week 8 None 47 (59.5) 39 (52.0) 32(41.0) Mild 22 (27.8) 20 (26.7) 24 (30.8) Moderate 6 (7.6) 5 (6.7) 13(16.7) Severe 2 (2.5) 1 (1.3) 2 (2.6) None or Mild 69 (87.3) 59 (78.7)56 (71.8) Week 12 None 51 (64.6) 39 (52.0) 33 (42.3) Mild 16 (20.3) 22(29.3) 30 (38.5) Moderate 10 (12.7) 11 (14.7) 12 (15.4) Severe 1 (1.3) 1(1.3) 2 (2.6) None or Mild 67 (84.8) 61 (81.3) 63 (80.8)

Clinical Erythema Assessment:

Both FMX103 doses appeared to reduce erythema (Table 87). Followingtreatment, a decrease in erythema was observed. At 12 weeks, the 1.5%and 3% doses of FMX103 were effective in reducing erythema, compared tothe vehicle-treated group (Table 87 and FIG. 3) as opposed to oralOrecea which had no effect on erythema. In particular, the majority ofsubjects in each treatment group (approximately 53% to 55% in eachgroup) had a clinical erythema assessment of moderate or severe. At Week12, a larger majority of subjects in the 1.5% and 3% FMX-103 groups(approximately 76% to 85%, respectively) had a clinical erythemaassessment of clear to mild vs. approximately 68% of subjects in thevehicle group. Thus, FMX103 advantageously reduced erythema in moderateto severe cases, as well as avoided systemic side effects.

TABLE 87 Summary of Changes from Baseline in Clinical ErythemaAssessment by Visit and Treatment Intent-to-Treat Population (MultipleImputation Method) Minocycline 1.5% Minocycline 3% Vehicle Visit (N =79) (N = 75) (N = 78) Parameter n (%) n (%) n (%) Week 2 Baseline Clear1 (1.3) 0 0 Almost Clear 12 (15.2) 7 (9.3) 7 (9.0) Mild 24 (30.4) 28(37.3) 28 (35.9) Moderate 33 (41.8) 31 (41.3) 36 (46.2) Severe 9 (11.4)9 (12.0) 7 (9.0) Post-Baseline Clear 0 2 (2.7) 0 Almost Clear 21 (26.6)12 (16.0) 10 (12.8) Mild 30 (38.0) 34 (45.3) 28 (35.9) Moderate 19(24.1) 21 (28.0) 34 (43.6) Severe 9 (11.4) 6 (8.0) 6 (7.7) Change inModerate or Severe Erythema Cases* −33% (42 to 28) −33% (40 to 27) −7%(43 to 40) Improved at Least 2 Levels 1 (1.3) 5 (6.7) 0 Did Not Improveat Least 2 Levels 78 (98.7) 70 (93.3) 78 (100.0) Week 4 Baseline Clear 1(1.3) 0 0 Almost Clear 12 (15.2) 7 (9.3) 7 (9.0) Mild 24 (30.4) 28(37.3) 28 (35.9) Moderate 33 (41.8) 31 (41.3) 36 (46.2) Severe 9 (11.4)9 (12.0) 7 (9.0) Post-Baseline Clear 3 (3.8) 2 (2.7) 1 (1.3) AlmostClear 22 (27.8) 18 (24.0) 12 (15.4) Mild 25 (31.6) 39 (52.0) 29 (37.2)Moderate 20 (25.3) 12 (16.0) 28 (35.9) Severe 9 (11.4) 4 (5.3) 8 (10.3)Change in Moderate or Severe Erythema Cases* −31% (42 to 29) −60% (40 to16) −16.3% (43 to 36) Improved at Least 2 Levels 4 (5.1) 7 (9.3) 1 (1.3)Did Not Improve at Least 2 Levels 75 (94.9) 68 (90.7) 77 (98.7) Week 8Baseline Clear 1 (1.3) 0 0 Almost Clear 12 (15.2) 7 (15.2) 7 (9.0) Mild24 (30.4) 28 (30.4) 28 (35.9) Moderate 33 (41.8) 31 (41.8) 36 (46.2)Severe 9 (11.4) 9 (11.4) 7 (9.0) Post-Baseline Clear 5 (6.3) 1 (1.3) 4(5.1) Almost Clear 23 (29.1) 21 (28.0) 10 (12.8) Mild 29 (36.7) 39(52.0) 33 (42.3) Moderate 17 (21.5) 12 (16.0) 26 (33.3) Severe 5 (6.3) 2(2.7) 5 (6.4) Change in Moderate or Severe Erythema Cases* −48% (42 to22) −65% (40 to 14) −28% (43 to 31) Change in Severe Erythema Cases**−44% (9 to 5) −78% (9 to 2) −28.6% (7 to 5) Improved at Least 2 Levels12 (15.2) 12 (16.0) 6 (7.7) Did Not Improve at Least 2 Levels 67 (84.8)63 (84.0) 72 (92.3) Week 12 Baseline Clear 1 (1.3) 0 0 Almost Clear 12(15.2) 7 (9.3) 7 (9.0) Mild 24 (30.4) 28 (37.3) 28 (35.9) Moderate 33(41.8) 31 (41.3) 36 (46.2) Severe 9 (11.4) 9 (12.0) 7 (9.0)Post-Baseline Clear 4 (5.1) 5 (6.7) 3 (3.8) Almost Clear 23 (29.1) 17(22.7) 15 (19.2) Mild 33 (41.8) 42 (56.0) 35 (44.9) Moderate 18 (22.8) 9(12.0) 20 (25.6) Severe 1 (1.3) 2 (2.7) 5 (6.4) Change in Moderate orSevere Erythema Cases* −55% (42 to 19) −73% (40 to 11) −42% (43 to 25)Change in Severe Erythema Cases** −89% (9 to 1) −78% (9 to 2) −28.6% (7to 5) Improved at Least 2 Levels 10 (12.7) 11 (14.7) 7 (9.0) Did NotImprove at Least 2 Levels 69 (87.3) 64 (85.3) 71 (91.0) *% reduction ofmoderate to severe cases out of number moderate to severe cases **%reduction of severe cases out of number severe cases

FMX103 vs. Oracea® (Oral Doxycycline 40 mg)²

Currently, Oracea® is the drug of choice for treatment of papulopustularrosacea. However, the current Phase 2 trial showed that FMX103 hadsurprising advantages, since it achieved greater effect despite ashorter treatment period (12 weeks vs. 16 weeks) and despite a higherbaseline severity of rosacea (both mean lesion count and IGA severity,see Table 88), while avoiding systemic adverse events associated withoral doxycyline. As shown in Table 88, the results for reduction ofabsolute mean lesion count of FMX103 (a 21 point reduction for the 1.5%group) and percent change of lesion count (61.4% for the 1.5% group)were all higher than the results observed with Oracea®.

TABLE 88 Summary of clinical trial results for FMX103 and Oracea(literature comparison) FMX103 1.5% Oracea ® Oral Doxycycline^(1, 2)Topical Minocycline (Week 16) (Week 12) Study 1 Study 2 Active VehicleActive Vehicle Active Vehicle Inflammatory Lesions Baseline No. oflesions 34.5 30.6 19.5 20.3 20.5 21.2 Mean Absolute Reduction −21.1 −7.8−11.8 −5.9 −9.5 −4.3 Mean Percent Reduction 61.4% −29.7%   — — — — IGABaseline Moderate   43% 51.3% 52.8% 52.4% 54.2% 55.6% IGA Severe   57%48.7% 40.9% 39.5% 33.8% 39.6% ≥2 IGA Grade Reduction 41.8% 17.9% 45.7%25.8% 22.5% 16.0% IGA = Clear/Almost Clear 25.3%  7.7% 30.7% 19.4% 14.8% 6.3% ¹Source: (1) Oracea Prescribing Information, December 2014; (2)Del Rosso et al, JAAD 56 (2007) 791-802 ²Literature Comparison: clinicaltrials are conducted under widely varying conditions, efficacy ratesobserved in the clinical trials of one drug cannot be directly comparedto rates in the clinical trials of another drug. Head-to-head trialswith FMX103 were not conducted.

Example 9 Pharmacokinetic Comparison of Once-Daily Topical MinocyclineFoam 4% Vs Oral Minocycline for Moderate-to-Severe Acne

Objective:

To characterize minocycline pharmacokinetics and relativebioavailability following multiple-dose topical administration ofminocycline hydrochloride (HCl) foam 4% (FMX-101 4%) as compared withsingle-dose oral of minocycline HCl extended-release tablets (Solodyn®)in in both adult and pediatric objects with moderate-to-severe acne.

Methods:

Two Phase I, single-center, nonrandomized, open-label,active-controlled, 2-period, 2-treatment crossover clinical studies wereconducted. One study included 30 healthy adults (mean age, 22.6 years;90% white, and 60% females) and the other included 20 pediatric subjects(mean age, 13.2 years; 65% black or African American, and 55% females)who had moderate-to-severe acne. Subjects were initially assigned toreceive a single oral dose of a minocycline HCl extended-release tablet(approximately 1 mg/kg) after an overnight fast of at least 10 hours(Period 1). At 10 days after the oral minocycline dose, topicalminocycline foam 4% was applied, once daily for 21 days (Period 2). Eachapplication was approximately 4 g (a maximal-use dose). Serial bloodsamples were obtained before and after administration of oralminocycline and each topical application of minocycline foam 4% on days1, 12, and 21. On the day of initial dosing (Day 1), subjects checkedinto the clinic where they were confined until 1 hour after study drugwas administered. Predose clinical assessments were performed and a 1 mLblood sample for PK analysis was obtained before study drug wasadministered. Pediatric subjects received a 4 g, once-daily topicalapplication of FMX101 4% for 7 days. Blood samples were collected at 3,12, 16, and 24 hours after application on day 7.

Subjects:

Adults were eligible for this study if they were 18 to 35 years of age;children were eligible for the pediatric study if they were 9 to 16years and 11 months of age and in good health, as judged on the basis oftheir medical history and the screening procedures. They were requiredto have moderate-to-severe facial acne vulgaris as well as acneaffecting at least two additional regions of the body (neck, upperchest, upper back, or arms). Body mass index of the subjects wasspecified to range from 18.5 to 29.9 kg/m². Use of tobacco and/ornicotine during the 30 days prior to the screening visit was prohibited,and all subjects were required to have a negative test for drug abuseand to be able to fully comply with the study requirements. All subjectsprovided written, informed consent.

Subjects were excluded if they met any one of the following criteria:female who was pregnant or lactating, or planning a pregnancy; use ofmedicated cleansers or topical acne treatment within 1 week prior toenrollment, or use of topical retinoids, anti-inflammatories,corticosteroids, or systemic antibiotics or other systemic acnetreatments within 4 weeks prior to enrollment, or use of systemicretinoids or corticosteroids within 12 weeks prior to enrollment; anyabnormal laboratory values at baseline; any dermatologic condition ofthe face or facial hair, or any other conditions that, in the opinion ofthe investigator, could have interfered with the clinical evaluations orthe course of the study, or exposed the subject to undue risk.

Sampling:

During Period 1, subjects received a single oral dose of minocycline;blood samples were obtained before dosing and through 96 hours (at 30minutes and at 1, 1.5, 2, 3, 4, 6, 9, 12, 16, 24, 48, 72, and 96 hours)after administration of oral minocycline. During Period 2, topicalminocycline foam 4% was applied daily for 21 days. Blood samples wereobtained before dosing and at 2, 4, 8, 12, 16, and 24 hours after thefirst topical application of minocycline foam 4% (Period 2, day 1). Ondays 6, 9, 10, 11, and 16, blood samples were obtained at approximately30 minutes before the scheduled application. On days 12 and 21, bloodsamples were obtained at 30 minutes before and at 2, 4, 8, 12, 16, and24 hours after topical application of minocycline foam 4%. Day 21 wasthe last day of application, at which time all assessments and safetyprocedures were performed. After the final application, subjects wereasked to return for additional blood sampling on days 23, 24, and 25.

Bioanalytical Methods:

Blood samples were collected and centrifuged, and the separated plasmawas stored at approximately −70° C. Plasma minocycline concentrationswere determined using validated liquid chromatography with a tandem massspectrometry detection method (Nuvisan GmbH); the limit of detection was0.270 ng/mL.

Pharmacokinetic Analyses:

Noncompartmental pharmacokinetic parameters for minocycline werecalculated for all subjects for each day during Period 1 and on days 1,12, and 21 for Period 2. Pharmacokinetic parameters included thefollowing: C_(max) (maximum plasma concentration); t_(max) (time ofmaximum measured plasma concentration); AUC_(0-inf) (area under theplasma concentration vs time curve [AUC] from time 0 to infinity);AUC_(0-tldc) (AUC from time 0 to the time of last detectableconcentration); t_(1/2) (terminal phase half-life); C₂₄ (minocyclineconcentration 24 hours after topical application of minocycline foam4%); and AUC_(0-tau) (AUC during the 24-hour dosing interval for topicalminocycline foam 4%).

AUC_(0-tldc) was calculated by the linear trapezoidal method, andAUC_(0-inf) was calculated as the sum of AUC_(0-tldc) plus the ratio ofthe last measurable plasma concentration to the terminal-phase rateconstant; both of these assessments were performed for the oralminocycline dose only. Accumulation ratio was calculated by dividing theAUC_(0-tau) of day 12 or day 21 by the AUC_(0-tau) of day 1 for day 12and day 21, respectively, where tau is 1 day (24 hours).

Safety Evaluation:

Safety was assessed by the evaluation of reported and observed adverseevents (AEs), vital signs (blood pressure, heart rate), clinicallaboratory assessments (hematology, chemistry, and urinalysis), andelectrocardiograms (ECGs). The number and percentage of subjects weredocumented for (1) any treatment-emergent AE (TEAE); (2) anytreatment-related TEAE (probable, possible); (3) any serious TEAE; (4)any severe TEAE; and (5) any TEAE leading to drug withdrawal. Theintensity, duration, and causal relationship to the investigationalproducts were rated for all AEs.

Statistical Analyses:

Descriptive statistics were reported for minocycline concentration dataat each sample time and were also calculated for all pharmacokineticparameters. Actual sample collection times were used for the purpose ofcalculating pharmacokinetic parameters. All deviations from thescheduled sampling time were reported in the final report as “SampleTime Deviations.” No values of kel, AUC_(0-inf), or t_(1/2) werereported for cases that did not exhibit a terminal log-linear phase inthe concentration vs time profile. Geometric mean was calculated forC_(max), AUC_(0-tldc), AUC_(0-inf), and AUC_(0-tau), and the harmonicmean was calculated for t_(1/2). Analysis of multiple-dose accumulation,determination of steady state, and other pertinent comparisons ofpharmacokinetic parameters across or between doses were performed usingthe appropriate statistical methods. The 90% confidence intervals (CIs)for the difference between treatment least squares means (LSMs) werecalculated for the parameters AUC (AUC_(0-inf), AUC_(0-tau)) and C_(max)using log-transformed data. Topical minocycline foam 4% (test treatment)was compared against oral minocycline (reference). The CIs wereexpressed as a percentage relative to the LSM of the referencetreatment.

Results:

In total, 30 subjects were enrolled, and all completed the study asplanned. The mean age of the subjects was 22.6 years (range, 18 to 30years). They were mostly white (90%) and female (60%). All subjects hadmoderate-to-severe acne at baseline evaluation. Treatment adherence ratewas high: only 2 subjects missed a single topical minocycline foam 4%application (on day 3) and only 1 subject missed multiple topicalminocycline foam 4% applications (on days 9, 10, and 11).

After a single oral dose of minocycline, plasma minocyclineconcentration increased until 3 hours (median t_(max) value), followedby a log-linear decrease over the remainder of the 96-hour samplingperiod (FIG. 4A). The geometric mean C_(max) was 850.04 ng/mL (Table89).

TABLE 89 Summary of PK Parameters (Pharmacokinetic ConcentrationPopulation) Following Single Dose Oral Administration of Solodyn (~1mg/kg minocycline) and Topical Application of FMX-101, 4% for 21 days toAcne Patients, Study FX2014-03 CV Geometric Harmonic PK Parameter N Mean(SD) Median Min, Max (%) Mean Mean Period 1, Solodyn (~1 mg/kgminocycline) Day 1-5 C_(max) (ng/mL) 30 873.367 (220.046) 801.00 603.00, 1620.00 25.20 850.049 — T_(max) (h) 30 2.7 (0.81) 3.0 1.5, 4.030.01 — — AUC _(0-ddc) (ng h/mL) 30 15227.30 (3624.298) 15363.00 9317.00, 25420.00 23.80 14823.41 — kel (1/h) 30 0.044 (0.005) 0.040.03, 0.05 11.52 — — AUC_(0-inf) (ng h/mL) 30 15474.57 (3690.744)15553.50  9387.00, 25697.00 23.85 15060.29 — T_(1/2) (h) 30 16.0 (1.85)15.9 12.8, 20.1 11.59 — 15.8 Period 2, FMX-101, 4% (4 g) Day 1-2 C_(max)(ng/mL) 30 1.706 (0.823) 1.50 0.68, 3.88 48.26 1.539 — T_(max) (h) 3011.5 (4.01) 12.0  4.0, 23.8 35.00 — — C₂₄ (ng/mL) 30 1.336 (0.667) 1.130.53, 3.09 49.91 1.192 — AUC_(0-tau) (ng h/mL)¹ 30 31.75 (14.950) 28.8110.87, 72.56 47.09 28.70 — Day 12-13 C_(max) (ng/mL) 29 1.325 (0.787)1.33 0.14, 3.27 59.40 1.063 — T_(max) (h) 29 9.4 (5.13) 8.0  0.0, 23.854.33 — — C₂₄ (ng/mL) 29 0.919 (0.531) 0.86 0.00, 2.01 57.76 0.869 —AUC_(0-tau) (ng h/mL)¹ 29 24.62 (14.100) 22.31  3.24, 55.69 57.26 20.06— Accumulation Ratio R² 29 0.85 (0.552) 0.76 0.00, 2.56 — — — Day 21-25C_(max) (ng/mL) 30 1.253 (0.645) 1.02 0.41, 2.73 51.52 1.109 — T_(max)(h) 30 12.3 (4.79) 14.0  4.0, 23.8 39.05 — — kel (1/h) 14 0.018 (0.006)0.02 0.01, 0.03 32.59 — — T_(1/2) (h) 14 44.3 (25.39) 37.8  26.7, 125.357.30 — 37.6 C₂₄ (ng/mL) 30 0.901 (0.406) 0.77 0.30, 1.89 45.11 0.821 —AUC_(0-tau) (ng h/mL)¹ 30 23.02 (10.798) 20.45  6.28, 46.85 46.91 20.70— Accumulation Ratio R² 30 0.79 (0.368) 0.62 0.39, 1.66 — — — SD =standard deviation. CV = coefficient of variation. Concentrations belowthe limit of quantitation (LOQ) were reported as zero for the purpose ofcalculating PK parameters. ¹AUC_(0-tau) = AUC during the 24-hour dosinginterval. ²On Day 12, R = AUC _(0-tau) Day 12/AUC _(0-tau) Day 1; On Day21, R = AUC _(0-tau) Day 21/AUC _(0-tau) Day 1. Source: Table 14.2.2.1.

Following topical application of a 4-g maximal-use dose of minocyclinefoam 4%, plasma minocycline concentration increased until 8 to 14 hours(median t_(max) value) on days 1, 12, and 21. The change in mean plasmaminocycline concentration with time following topical application ofminocycline foam 4% is shown in FIG. 4B. The plasma concentration at 24hours after topical application of minocycline foam 4% was low;geometric mean C₂₄ values on days 1, 12, and day 21 were 1.192, 0.869,and 0.821 ng/mL, respectively (Table 89). A comparison of the plasmaminocycline concentration vs time profiles over the first 24 hours afteroral minocycline or topical minocycline foam 4% administration is shownin FIG. 4C. Overall, the plasma minocycline concentration followingtopical application of minocycline foam 4% was very low; the geometricmean C_(max) values ranged from 1.1 ng/mL to 1.5 ng/mL (Table 89).

Steady state for topical application of minocycline foam 4% was achievedby day 6 (FIG. 5). Relative bioavailability of minocycline after topicalminocycline foam 4% administration, as compared with oral minocycline,for day 12 and day 21 was 0.126% and 0.131%, respectively, based onC_(max), and it was 0.134% and 0.137%, respectively, based on AUC values(Table 90). Minocycline exposure following daily topical application ofminocycline foam 4% was 730 to 765 times lower than that following asingle oral dose of −1 mg/kg minocycline. The daily dosing of topicalminocycline foam 4% was associated with a mean (range) accumulationratio of 0.85 (0.00, 2.56) and 0.79 (0.39, 1.66) at day 12 and day 21,respectively (Table 89). There was no evidence that minocycline hadaccumulated during the 21 days of topical application of minocyclinefoam 4%. In pediatric subjects, following topical application of FMX1014% for 7 days, the overall average plasma concentration of minocyclineacross all ages was 2.5 ng/mL (relatively constant over the entiresampling interval). See Table 92. Concentrations tend to be higher foryounger age groups (9-11 years: 3.5 ng/mL; 12-14 years: 2.5 ng/mL) thanfor the older age group (15-16 years, 11 months: 1.7 ng/mL). The meanoverall maximum observed plasma concentration (C_(max)) plasmaminocycline concentration 24 hours after FMX101 application (C₂₄), andarea under the concentration-time curve from time zero (predose) through24 hours (AUC_(0-tau)) were approximately 3.1 ng/mL, 2.5 ng/mL, and 61ng*h/mL, respectively. See Table 93. C_(max), C₂₄, and AUC_(0-tau)tended to be higher in the subjects aged 9 to 11 years and subjects aged12 to 14 years than the subjects aged 15 years to 16 years 11 months,however the small sample size precludes making any conclusions regardingthe effect of age on these PK parameters.

In both studies, FMX101 4% was safe and well-tolerated. There were nodrug-related treatment-emergent adverse events (TEAEs), no TEAEs thatled to treatment discontinuation, and no serious adverse events.Overall, there was a high rate of subject satisfaction with the use ofFMX101, 4%. A majority of subjects reported they were “satisfied” or“very satisfied” with the treatment compared with topical acne therapiesused previously. Additionally, the subjects were satisfied with the feelof the foam on the skin.

TABLE 90 Summary of minocycline relative bioavailability with oralminocycline administration and topical application of minocycline foam4% at days 12 and 21. Topical minocycline foam 4% (FMX-101) vs oralGeometric LSM Ratio (%) minocycline (Solodyn N (GMR),^(a) % (90% CI) Day12 C_(max) 29 0.126 (0.100, 0.159) Day 12 AUC^(b) 29 0.134 (0.110,0.163) Day 21 C_(max) 30 0.131 (0.113, 0.151) Day 21 AUC^(c) 30 0.137(0.121, 0.156) Notes ^(a)The 90% confidence intervals for the differencebetween Test (topical minocycline foam 4%) and Reference (oralminocycline (Solodyn) treatment least squares mean values werecalculated using natural logarithm-transformed C_(max) and AUC values.Geometric LSM ratio (GMR) and the associated 90% CI are back transformedpoint estimate and the associated 90% CI. ^(b)Day 12 AUC_(0-tau) fortopical minocycline foam 4% (FMX-101) vs AUC_(0-inf) for oralminocycline (Solodyn). ^(c)Day 21 AUC_(0-tau) for topical minocyclinefoam 4% vs AUC_(0-inf) (FMX-101) for oral minocycline (Solodyn).Abbreviations: AUC, area under the curve; C_(max), maximum plasmaconcentration; CI, confidence interval; AUC_(0-inf), AUC from time 0 toinfinity; AUC_(0-tau), AUC during the 24-hour dosing interval fortopical minocycline foam 4%.

Safety Evaluation in Adults:

Once-daily application of topical minocycline foam 4% for 21 days waswell tolerated. There was minimal systemic absorption and accumulationof minocycline over the 21 days of topical application of minocyclinefoam 4% as compared with oral minocycline. The most common TEAEsobserverd were dysmenorrhea, nasal congestion, and rhinorrhea, alloccurring in the topical minocycline foam treatment period (Table 91).In the oral minocycline treatment period, 2 subjects (6.7%) reported atotal of 2 TEAEs, while 9 subjects (30%) in the topical minocycline foam4% treatment period reported a total of 14 TEAEs. There were no TEAEsconsidered to be related to the study medication. There were also noserious TEAEs, severe TEAEs, or TEAEs that resulted in study medicationbeing withdrawn, as well as no clinically significant laboratoryfindings in any subjects.

Safety Evaluation in Pediatrics:

Once-daily application of topical minocycline foam 4% for 7 days wassafe and well tolerated. There were no TEAEs considered related to studydrug. There were no clinically significant laboratory findings in anysubject. Adverse events are summarized in Table 94. One subject (5.0%)reported a total of 2 TEAEs (nausea and vomiting). There were no seriousTEAEs, no severe TEAEs, and no TEAEs that resulted in study medicationbeing withdrawn. No TEAEs associated with laboratory abnormalities orvital signs were reported. No clinically significant abnormal physicalexamination findings were reported for any subject.

TABLE 91 Overall summary of AEs following administration of oralminocycline and topical application of minocycline foam 4% daily for 21days. Topical Oral minocycline minocycline foam (N = 30) 4% (N = 30)Subjects with treatment-related^(a) TEAE, 0 0 n (%) Subjects withserious TEAE, n (%) 0 0 Subjects with TEAE leading to study 0 0discontinuation, n (%) Subjects with any TEAE^(a), n (%) 2 (6.7)  9(30.0) Dysmenorrhea 0 2 (6.7) Nasal congestion 0 2 (6.7) Rhinorrhea 0 2(6.7) Asthma 0 1 (3.3) Bronchitis 0 1 (3.3) Cough 1 (3.3) 0 Dermatitiscontact 0 1 (3.3) Headache 1 (3.3) 0 Oropharyngeal pain 0 1 (3.3)Pharyngitis streptococcal 0 1 (3.3) Respiratory tract congestion 0 1(3.3) Tonsillitis 0 1 (3.3) Notes ^(a)Subjects with one or more TEAEsthat were considered possibly or probably related. ^(b)Subjects with oneor more TEAEs are only counted once. Abbreviations: TEAE,treatment-emergent adverse event.

TABLE 92 Plasma Concentrations of Minocycline in Pediatric Acne PatientsTreated with FMX101 Mean (SD) Concentrations of Minocycline in Plasma(ng/mL) Cohort 1 Cohort 2 Cohort 3 Day and Time (9 to 11 years) (12 to14 years) (15 to 16 years 11 months) Overall of Sample¹ (N = 6) (N = 8)(N = 6) (N = 20) Day 1, Predose 0.000 (0.0000) 0.000 (0.0000) 0.000(0.0000) 0.000 (0.0000) Day 7, Predose 3.700 (4.3614) 2.111 (2.3463)1.870 (1.2783) 2.515 (2.8473) Day 7, 3 hours 3.693 (3.9303) 2.164(2.0046) 1.803 (1.1810) 2.514 (2.5618) Day 8, 12 hours 3.972 (3.8346)2.233 (1.8408) 1.775 (0.9688) 2.617 (2.4961) Day 8, 16 hours 3.780(3.7667) 2.263 (1.9884) 1.620 (0.9149) 2.525 (2.4891) Day 8, 24 hours3.663 (3.2094) 2.446 (1.8781) 1.479 (0.8684) 2.521 (2.2284) Source:Table 14.2.1 Abbreviations: SD = standard deviation ¹As the Day 7 dosewas applied in the evening, some samples were collected on calendar Day8, but PK parameters calculated from data obtained within approximately24 hours of the Day 7 dose are referred to as Day 7 parameters in thisclinical study report.

TABLE 93 Summary of Pharmacokinetic Parameters of Minocycline inPediatric Acne Patients Treated with FMX101 Mean (SD) PharmacokineticParameters¹ of Minocycline in Plasma C_(max) T_(max) C₂₄ AUC_(0-tau)Cohort and Age (ng/mL) (h)² (ng/mL) (ng * h/mL) Cohort 1 (9 to 11 years)4.447 (3.9687) 12 (0, 24) 3.663 (3.2094) 90.861 (90.1626) (N = 6) Cohort2 (12 to 14 years) 2.783 (2.1505) 20 (0, 24) 2.446 (1.8781) 54.015(46.2250) (N = 8) Cohort 3 2.036 (1.1676)  6 (0, 24) 1.479 (0.8684)40.797 (23.7635) (15 to 16 years 11 months) (N = 6) Overall 3.058(2.6792) 12.1 (0, 24)   2.521 (2.2284) 61.104 (59.2125) (N = 20) Source:Table 14.2.2 Abbreviations: AUC_(0-tau) = area under theconcentration-time curve (ng/mL * hours) from time zero (predose)through 24 hours; C₂₄ = plasma minocycline concentration 24 hours afterFMX101 application; C_(max) = maximum observed plasma concentration; SD= standard deviation; T_(max) = time to maximum measured plasmaconcentration. ¹Terminal phase rate constant (kel) and apparent terminalphase half-life (T_(1/2)) were not estimable because either there werefewer than 3 values in the terminal phase, the slope was positive, orthe T_(1/2) estimate was more than half the range of the terminal phase.²Median (minimum, maximum) shown for T_(max).

TABLE 94 Overall Summary of Adverse Events (Safety Population) FollowingTopical Application of FMX101, 4% for 7 Days to Pediatric Acne Patients,Study FX2016-21 All Subjects (N = 20) Subjects with Any TEAE, N (%) 1(5.0) Number of TEAEs 2 Subjects with Any Treatment-Related TEAE, N (%)¹0 Number of Treatment-Related TEAEs 0 Subjects with Any Serious TEAE, N(%) 0 Number of Serious TEAEs 0 Subjects with Any Severe TEAE, N (%) 0Number of Severe TEAEs 0 Subjects with Any TEAE Leading to 0 DrugWithdrawn, N (%) Number of TEAEs Leading to Drug Withdrawn 0 Source:Table 14.3.1.1 Abbreviations: N = number of subjects; TEAE =treatment-emergent adverse event. Note: TEAEs were defined as AEs withan onset date on or after the date of the first dose of study drug orexisting events that worsened after the first study drug applicationduring the study. ¹Treatment-related AEs included possibly and probablyrelated.

This Phase 1 study in adults evaluated the pharmacokinetics andbioavailability of minocycline in multiple-dose, once-daily topicalapplication of minocycline foam 4%, as compared with oral administrationof minocycline HCl. The pharmacokinetic results demonstrated minimalsystemic absorption and accumulation of minocycline following themaximal-use dose of topical minocycline foam 4% for 21 days, as comparedwith oral minocycline. Topical minocycline foam 4% was well tolerated inonce-daily application in subjects with AV, with no serious or severeAEs or AEs related to study medication or resulting in treatmentdiscontinuation.

Systemic exposure to minocycline with daily topical application of the4-g dose of minocycline foam 4% for 21 days was 730 to 765 times lowerthan that following a single, oral, ˜1 mg/kg dose of minocycline. Therewas no evidence of accumulation of minocycline over the 21 days ofonce-daily topical application of a 4-g maximal-use dose of minocyclinefoam 4%. The observation of slightly higher mean minocycline values(C_(max)) on day 1 than on day 12 or day 21 was probably due to residualminocycline from the oral minocycline dose that had been administered 10days prior to the start of topical minocycline foam 4% application.Plasma minocycline values were measurable for the majority of subjectsbefore topical minocycline foam 4% application; however, thisobservation was considered to have no impact on the interpretation ofthe results.

In this study, all AEs were reported, and vital signs and clinicallaboratory assessments, including hematology, chemistry and urinalysis,were monitored. Overall, topical minocycline foam 4% was well toleratedfollowing multiple-dose administration for up to 21 days. The mostcommon TEAEs were dysmenorrhea, nasal congestion, and rhinorrhea. Therewere no treatment-related AEs, no serious or severe TEAEs, and noserious TEAEs that led to withdrawal from the study.

Common systemic adverse reactions reported in clinical trials with oralminocycline have included headache, fatigue, dizziness, and itch, whichwere not seen in this study. There were also no reported cases ofautoimmune conditions, such as drug-induced lupus-like syndrome, nor ofskin and hypersensitivity reactions that have been associated with oralminocycline. There were no findings of clinically significantabnormalities of laboratory values or vital signs, or abnormalities inECGs or physical examinations in any subjects. Acne severity did notworsen in subjects after 21 days of using topical minocycline foam 4%.

CONCLUSION: In both adult and pediatric subjects, the plasmaconcentration of minocycline was low after topical application of FMX1014%. No significant systemic exposure to minocycline was observed withonce-daily topical application of FMX101 4% for 21 days in adults and 7days in pediatric subjects. FMX101 4% appears to be a well-toleratedtreatment option for both pediatric and adult subjects withmoderate-to-severe acne.

Without being bound by any theory, the improved patient satisfactionwith the use of FMX101, 4%, may correlate at least in part with thelower blood exposure of the minocycline after application of the FMX101,4% formulation versus oral administration of SOLODYN®. Additionally, thelower blood exposure of the minocycline in patients treated with FMX101,4% may correlate with a lower incidence of treatment-related adverseevents.

Example 10 Changes in RosaQoL Index Score at Week 12 from Baseline

RosaQoL (Rosacea Quality of Life) index scores, measuring the impact ofrosacea treatment on health-related quality of life, indicated that bothdoses of FMX103 were significantly better than the vehicle foam inimproving the RosaQoL overall score from baseline at Week 12 (p=0.003and p=0.036, respectively) (FIG. 6). Significant improvement at Week 12was demonstrated in the symptom subscale scores for both doses of FMX103and in the emotional subscale scores for FMX103 1.5%, as compared tovehicle foam. Post hoc analyses of global questions to assesspatient-reported outcomes showed a similar trend. For the question, “Howdo you rate your rosacea over the past 4 weeks?”, approximately 52percent and 54 percent of the FMX103 1.5% and 3% groups, respectively,answered “good” to “excellent,” as compared to approximately 20 percentof subjects in the vehicle foam group at Week 12 (both p<0.001).Approximately 75 percent in both treatment groups also reported “better”to the comparative question, “How is your rosacea compared to the lasttime you filled out this survey?”, while approximately 42 percent ofsubjects in the vehicle group at Week 12 answered “better” to the samequestion (both p<0.001).

Compliance with study drug dosing was high, with rates of 97.5, 94.7,and 98.7 percent in the FMX103 1.5%, FMX103 3%, and vehicle foam groups,respectively. The number of grams of study drug used per day was alsosimilar among treatment groups: 0.36, 0.38, and 0.39 g for FMX103 1.5%,FMX103 3%, and vehicle, respectively.

Having described preferred embodiments of the compositions and methodswith reference to the accompanying drawings, it is to be understood thatthe compositions and methods provided herein are not limited to theprecise embodiments, and that various changes and modifications can beeffected therein by those skilled in the art without departing from thescope or spirit of the disclosure as defined in the appended claims.

What is claimed is:
 1. A method for treating acne vulgaris in a subjectin need thereof, comprising topically administering to the subject atherapeutically effective amount of a breakable foam obtained from afoamable composition once daily for at least seven consecutive days,wherein the foamable composition comprises: (a) a hydrophobic vehiclecomprising: (i) about 70% to about 90% by weight of a hydrophobicsolvent comprising: about 50% w/w of soybean oil; about 16.5% w/w toabout 30.7% w/w of coconut oil; about 3.5% w/w to about 6.5% w/w ofcyclomethicone; and about 1% w/w to about 6% w/w of light mineral oil;and (ii) about 10% to about 22% by weight of a foamer complexcomprising: about 3.5% w/w of cetostearyl alcohol; about 2% w/w to about4% w/w of stearic acid; about 1.8% w/w to about 3.3% w/w of myristylalcohol; about 1% w/w to about 3% w/w of hydrogenated castor oil; about1% w/w to about 3% w/w of beeswax; about 1% w/w to about 2% w/w ofstearyl alcohol; and about 0.5% w/w to about 1.5% w/w of behenylalcohol; (iii) minocycline in an amount ranging from about 1% w/w toabout 4% w/w; and (b) a propellant in an amount ranging from about 3% toabout 25% w/w; and wherein the foamable composition does not comprisessilicon dioxide (SiO₂), wherein seven days of topical treatment with thebreakable foam at the therapeutically effective amount results in amaximum concentration of minocycline in plasma from the subject of about2 ng/mL, as measured during a 24 hour period following the last topicaladministration, and wherein the subject is between 15 years old and 16years and 11 months old.
 2. The method of claim 1, wherein seven days oftopical treatment with the therapeutically effective amount results in aconcentration of minocycline in plasma from the subjects of about 1.4ng/mL to about 3.7 ng/mL, as measured 24 hours after the last topicaladministration.
 3. The method of claim 1, wherein the area under aconcentration-time curve of the amount of the minocycline in the plasmaof the subjects is determined during a 24 hour period following the lasttopical administration.
 4. The method of claim 3, wherein the area underthe concentration-time curve of the minocycline in the plasma is about40.8 ng/mL*hour.